Bolt Eye Group - Riverdale, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

BOLT EYE GROUP - RIVERDALE, LLC

Doing business as

Bolt Eye Group

Practice address

131 Upper Riverdale Rd SW
Riverdale, GA 30274-2540

Phone

(770) 994-9913

NPI assigned

Jan 12, 2023

Organization subpart

No

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

Authorized official

Name

Susan Marie Reimbold, ODNPI 1033236492

Title

Owner

Phone

(770) 776-9000

Specialties & licenses 1

Addresses

Other names 1

• Bolt Eye Group Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan Marie Reimbold, O.D.

  • Optometrist
  • Alpharetta, GA
  • NPI 1033236492
  Medicare reassignment Care Compare group NPD Authorized official
• Duy Hoang Nguyen

  • Optometrist
  • Atlanta, GA
  • NPI 1801562715
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1673481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680652800000",
    "number": "1588378632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4180 OLD MILTON PKWY STE 1D",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300052408",
            "telephone_number": "770-776-9000",
            "fax_number": "678-293-8499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 UPPER RIVERDALE RD SW",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742540",
            "telephone_number": "770-994-9913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLT EYE GROUP - RIVERDALE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-12",
        "last_updated": "2023-04-05",
        "certification_date": "2023-04-05",
        "status": "A",
        "authorized_official_last_name": "REIMBOLD",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-776-9000",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drsusan@reimboldeye.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "131 Upper Riverdale Rd SW",
            "city": "Riverdale",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302742540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Bolt Eye Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deepak Bhagwandas, PT,MD
• John B Black, MD
• Tashi Blake
• Evelinn Suarez Blanks, WHNP
• Andrew Board
• Geetha Maheswaramma Bommana, MD
• Aparna Bondalapati
• Berta E Booth, PA
• Octavia Bostic
• Michael Bourland, MD

• Optometrist in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2023; 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.