NPIMap

Organization Active NPI

Premier Ophthalmology, LLC

  • Eyewear Supplier
  • Covington, GA
National Provider Identifier
1548315252
Registry record updated Aug 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
6856 Issued in GA
Legal business name
PREMIER OPHTHALMOLOGY, LLC
Practice address
7170 Highway 278 NE
Suite B
Covington, GA 30014-1529
Phone
(770) 787-6200
Fax
(770) 787-2643
NPI assigned
Jan 24, 2007
Last updated
Aug 2, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2012

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

Authorized official

Name
Bradley G Jacoby, M.D.NPI 1174605372
Title
Physician Owner
Phone
(770) 787-6200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X 6856 GA Primary

Addresses

Primary practice location

7170 Highway 278 NE
Suite B
Covington, GA 30014-1529

Mailing address

7170 Highway 278 NE
Suite B
Covington, GA 30014-1529
Phone (770) 787-6200

Other identifiers 1

IdentifierTypeStateIssuer
000326697BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930019843 GA DME Supplier - Physician - Ophthalmology 5597750513 Practice locations: Covington, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Premier Ophthalmology LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7170 Highway 278 NE
Ste B
Covington, GA 30014
Phone (770) 787-6200

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343865600000",
    "number": "1548315252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7170 HIGHWAY 278 NE",
            "address_2": "SUITE B",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300141529",
            "telephone_number": "770-787-6200",
            "fax_number": "770-787-2643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7170 HIGHWAY 278 NE",
            "address_2": "SUITE B",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300141529",
            "telephone_number": "770-787-6200",
            "fax_number": "770-787-2643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER OPHTHALMOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2012-08-02",
        "status": "A",
        "authorized_official_last_name": "JACOBY",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "770-787-6200",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "GA",
            "license": "6856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000326697B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.