NPIMap

Organization Active NPI

Mehdi Kazemzadeh, Optometrist, P C

  • Optometrist
  • Lawrenceville, GA
National Provider Identifier
1487974853
Registry record updated May 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1423 Issued in GA
Legal business name
MEHDI KAZEMZADEH, OPTOMETRIST, P C
Practice address
575 Professional Dr
100
Lawrenceville, GA 30046-3333
Phone
(678) 993-2020
Fax
(678) 993-2000
NPI assigned
Jun 8, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2013

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

Authorized official

Name
Mehdi Kazemzadeh, OD
Title
Owner
Phone
(678) 993-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1423 GA Primary

Addresses

Primary practice location

575 Professional Dr
100
Lawrenceville, GA 30046-3333

Mailing address

575 Professional Dr
100
Lawrenceville, GA 30046-3333
Phone (678) 993-2020

Other identifiers 1

IdentifierTypeStateIssuer
000824865BMedicaidGA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1275955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367539200000",
    "number": "1487974853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 PROFESSIONAL DR",
            "address_2": "100",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463333",
            "telephone_number": "678-993-2020",
            "fax_number": "678-993-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 PROFESSIONAL DR",
            "address_2": "100",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463333",
            "telephone_number": "678-993-2020",
            "fax_number": "678-993-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEHDI KAZEMZADEH, OPTOMETRIST, P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-08",
        "last_updated": "2013-05-03",
        "status": "A",
        "authorized_official_last_name": "KAZEMZADEH",
        "authorized_official_first_name": "MEHDI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-993-2020",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "1423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000824865B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.