Individual provider Active NPI

Emily Rose Lasalle, O.D.

  • Optometrist
  • Canton, GA
National Provider Identifier
1528080710
Registry record updated Jan 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
003225 Issued in GA
Practice address
1810 Cumming Hwy SPC F-1010
Canton, GA 30115-2986
Phone
(770) 704-9666
Fax
(614) 856-0534
NPI assigned
Jul 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5621 OH
Optometrist 152W00000X 003225 GA Primary

Addresses

Primary practice location

1810 Cumming Hwy SPC F-1010
Canton, GA 30115-2986

Mailing address

732 Crescent Cir
Canton, GA 30115-4771
Phone (614) 638-3140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, GA, FL3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20121107000079 SC Practitioner - Optometry 5193720407 Reassigns benefits to 1 organization
I20200331003482 GA Practitioner - Optometry 5193720407 Reassigns benefits to 2 organizations
I20251107001480 FL Practitioner - Optometry 5193720407 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

36 Maple St
Kearny, NJ 07032-1927

8990 N Davis Hwy
Pensacola, FL 32514-5305

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1733SCMDProfessional Counselor
5621OHMDClinical Psychologist
003225GAMDOptometrist

Practice roles (6 of 7)

OrganizationSpecialtyStatusNew patients
S & H Eye Care, LLC Optometrist CurrentSince Nov 1, 2012 Accepting new patients
S & H Eye Care, LLC Optometrist Current Accepting new patients
Ga Doctors of Optometry LLC Optometrist CurrentSince Mar 22, 2022 Accepting new patients
Friendly Eyes Optometry LLC CurrentSince Oct 1, 2025 Accepting new patients
A. Dylan Reach, OD, PC Optometrist CurrentSince Mar 2, 2020 Accepting new patients
Ga Doctors of Optometry LLC Optometrist CurrentSince Mar 22, 2022 Accepting new patients

Locations

4900 Ivey Rd NW
Ste 1226
Acworth, GA 30101
Phone (678) 279-1141

4900 Ivey Rd NW
Ste 12226
Acworth, GA 30101
Phone (770) 974-3153

1810 Cumming Hwy
Spc F1010
Canton, GA 30115
Phone (770) 704-9666

50 Main Street Market Pl SE
Ste 100
Cartersville, GA 30121
Phone (770) 382-6379

1055 Silver Bluff Rd
Ste A
Aiken, SC 29803
Phone (803) 642-4339

11 Robert Smalls Pkwy
Ste H
Beaufort, SC 29906
Phone (843) 524-8302

Networks

  • Freedom Health HMO Network

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674172800000",
    "number": "1528080710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 CRESCENT CIR",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301154771",
            "telephone_number": "614-638-3140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 CUMMING HWY SPC F-1010",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301152986",
            "telephone_number": "770-704-9666",
            "fax_number": "614-856-0534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASALLE",
        "first_name": "EMILY",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "5621",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "003225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

Verify at the official NPI Registry.