Envision Eyecare LLC
Organization Active NPI Optometrist · Lithia Springs, GA
NPI 1407246010 · NPPES record last updated Nov 16, 2023
Key facts
- NPI
- 1407246010
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- OPT002829 (GA)
- Legal business name
- ENVISION EYECARE LLC
- Practice address
- 1100 Thornton Rd
Lithia Springs, GA 30122-2616 - Phone
- (770) 819-4981
- NPI assigned
- Feb 3, 2015
- Organization subpart
- No
Authorized official
- Name
- Dr. Ratidzo Bonnie Macharaga, O.D
- Title
- Owner/Optometrist
- Phone
- (404) 290-3700
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150304002295 | GA | Part B Supplier - Clinic/Group Practice | 1557687886 |
Receives reassigned benefits from 1 practitioner Practice locations: Bremen, GA; Carrollton, GA; Lithia Springs, GA; Villa Rica, GA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | OPT002829 | GA | Yes |
Addresses
Primary practice location
1100 Thornton Rd
Lithia Springs, GA 30122-2616
Mailing address
541 10TH St NW # 285
Atlanta, GA 30318-5713
Other practice location 1
404 Hwy 27 N Byp
Bremen, GA 30110-1950
Phone (770) 537-6386
Other practice location 2
600 Carrollton Villa Rica Hwy
Villa Rica, GA 30180-4969
Phone (770) 459-8733
Other practice location 3
1735 S Highway 27
Carrollton, GA 30117-8941
Phone (770) 214-7310
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All providers in Lithia Springs, GA · Optometrist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.