Individual provider Active NPI

Brian Schultz, O.D.

  • Optometrist
  • Johns Creek, GA
National Provider Identifier
1467563924
Registry record updated Apr 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT002338 Issued in GA
Practice address
97000 Medlock Bridge Rd
Sw120B
Johns Creek, GA 30097-4408
Phone
(770) 558-1850
Fax
(678) 691-8056
NPI assigned
Aug 31, 2006
Last updated
Apr 19, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT002338 GA Primary

Addresses

Primary practice location

97000 Medlock Bridge Rd
Sw120B
Johns Creek, GA 30097-4408

Mailing address

97000 Medlock Bridge Rd
Sw120B
Johns Creek, GA 30097-4408
Phone (770) 558-1850

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080609000653 GA Practitioner - Optometry 3870515869 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

9700 Medlock Bridge Rd
Suite 120B
Johns Creek, GA 30097-4408
Phone (770) 558-1850

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT002338GAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Maggie Mooo LLC CurrentSince Dec 1, 2021 Accepting new patients
Hiram Vision Center, Inc. Optometrist Past Accepting new patients

Locations

9700 Medlock Bridge Rd
Ste 120B
Johns Creek, GA 30097
Phone (770) 558-1850

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650326400000",
    "number": "1467563924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97000 MEDLOCK BRIDGE RD",
            "address_2": "SW120B",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300974408",
            "telephone_number": "770-558-1850",
            "fax_number": "678-691-8056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97000 MEDLOCK BRIDGE RD",
            "address_2": "SW120B",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300974408",
            "telephone_number": "770-558-1850",
            "fax_number": "678-691-8056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHULTZ",
        "first_name": "BRIAN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johns Creek, GA

Sources for this page

Verify at the official NPI Registry.