Gwinnett Eye Clinic

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT000841

Legal business name

GWINNETT EYE CLINIC

Practice address

3455 Peachtree Industrial Blvd
Suite 845
Duluth, GA 30096-6501

Phone

(770) 476-3606

Fax

(770) 476-2818

NPI assigned

Mar 22, 2007

Organization subpart

No

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

Authorized official

Name

Karen E Pitts

Title

MGN

Phone

(770) 476-3606

Specialties & licenses 1

Addresses

Other identifiers 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.

• Phillip E Johnson, O.D.

  • Optometrist
  • Duluth, GA
  • NPI 1184703464
  Medicare reassignment NPD
• Fabius Clements IV, O.D.

  • Optometrist
  • Duluth, GA
  • NPI 1790152858
  NPD (past)

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235520000000",
    "number": "1619093531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3455 PEACHTREE INDUSTRIAL BLVD",
            "address_2": "SUITE 845",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300966501",
            "telephone_number": "770-476-3606",
            "fax_number": "770-476-2818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 PEACHTREE INDUSTRIAL BLVD",
            "address_2": "SUITE 845",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300966501",
            "telephone_number": "770-476-3606",
            "fax_number": "770-476-2818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GWINNETT EYE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2009-02-25",
        "status": "A",
        "authorized_official_last_name": "PITTS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MGN",
        "authorized_official_telephone_number": "770-476-3606"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": "OPT000841",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00147672C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gwinnett Clinic, LTD
• Gwinnett Clinic, LTD
• Gwinnett Clinic, LTD
• Gwinnett Ear Nose & Throat, LLC
• Gwinnett Endoscopy Services, LLC
• Gwinnett Health Centers LLC
• Gwinnett Multi Specialty Group LLC
• Gwinnett Ophthalmology PC
• Gwinnett Orthopaedic & Sports Medicine
• Gwinnett Pulmonary Group Duluth

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2009; 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.