Individual provider Active NPI

Grigoriy Solomon, O.D

  • Corneal and Contact Management Optometrist
  • Decatur, GA
National Provider Identifier
1609831338
Registry record updated Feb 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Corneal and Contact Management OptometristTaxonomy code 152WC0802X
License
OPT002033 Issued in GA
Practice address
1781 Clairmont Rd
Decatur, GA 30033-4072
Phone
(404) 471-9990
Fax
(404) 471-9910
NPI assigned
Apr 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management Optometrist 152WC0802X OPT002033 GA Primary

Addresses

Primary practice location

1781 Clairmont Rd
Decatur, GA 30033-4072

Mailing address

2383 Waterford CV
Decatur, GA 30033-1332
Phone (404) 634-7210

Other identifiers 1

IdentifierTypeStateIssuer
000962662BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20031121000056 GA Practitioner - Optometry 6800790957 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Suwanee Eye CenterGroup PAC ID 8022081736, 2 clinicians

Practice addresses (Care Compare)

1781 Clairmont Rd
Decatur, GA 30033-4005
Phone (404) 471-9990

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT002033GAMDCorneal and Contact Management Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Suwanee Eye Center CurrentSince May 27, 2004 Accepting new patients
Tulman Eye Group, PC PastSince Jul 20, 2017 Accepting new patients

Locations

1781 Clairmont Rd
Decatur, GA 30033
Phone (404) 471-9990

Organizations & group practices 2

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": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423612800000",
    "number": "1609831338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2383 WATERFORD CV",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300331332",
            "telephone_number": "404-634-7210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1781 CLAIRMONT RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300334072",
            "telephone_number": "404-471-9990",
            "fax_number": "404-471-9910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOLOMON",
        "first_name": "GRIGORIY",
        "name_prefix": "Dr.",
        "credential": "O.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2015-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "GA",
            "license": "OPT002033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000962662B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

Verify at the official NPI Registry.