Eagle View Eye Care, LLC
Organization Active NPI Optometrist · Oakwood, GA
NPI 1508495474 · NPPES record last updated Oct 7, 2021
Key facts
- NPI
- 1508495474
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- EAGLE VIEW EYE CARE, LLC
- Practice address
- 4008 Mundy Mill Rd
Oakwood, GA 30566-2807 - Phone
- (706) 576-7238
- Fax
- (706) 640-3877
- NPI assigned
- Apr 3, 2020
- Organization subpart
- No
Authorized official
- Name
- Dr. Derek Alan Black, OD
- Title
- Owner/Member
- Phone
- (404) 697-2850
Practitioners 6
-
Rohan Kapoor, O.D.
-
Alayna Larsen, OD
-
Derek Alan Black, O.D.
-
Jeffrey Ray Kuck, OD
-
Mark Machen, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210308000835 | GA | Part B Supplier - Clinic/Group Practice | 7214348259 |
Receives reassigned benefits from 6 practitioners Practice locations: Cumming, GA; Oakwood, GA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
4008 Mundy Mill Rd
Oakwood, GA 30566-2807
Mailing address
4008 Mundy Mill Rd
Oakwood, GA 30566-2807
Phone (706) 576-7283
Other practice location 1
1211 Bald Ridge Marina Rd
Cumming, GA 30041-8484
Phone (470) 239-6625
Other names
- Lanier Eye Care, LLC
Other providers in Oakwood, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 7, 2021. 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.