Organization Active NPI

Bethel Eyecare

  • Optometrist
  • Duluth, GA
National Provider Identifier
1619274941
Registry record updated Feb 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2370 Issued in GA
Legal business name
BETHEL EYECARE
Practice address
2148 Duluth Hwy Ste 102
Duluth, GA 30097-4504
Phone
(770) 817-3990
Fax
(770) 817-3991
NPI assigned
Feb 23, 2011
Last updated
Feb 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2011

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

Authorized official

Name
Dr. Susie Cha, O.D.NPI 1811196033
Title
Member
Phone
(770) 817-3990

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
Optometrist 152W00000X 2370 GA Primary

Addresses

Primary practice location

2148 Duluth Hwy Ste 102
Duluth, GA 30097-4504

Mailing address

2148 Duluth Hwy Ste 102
Duluth, GA 30097-4504
Phone (770) 817-3990

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110310000216 GA Part B Supplier - Clinic/Group Practice 4183806235 Receives reassigned benefits from 1 practitioner
Practice locations: Duluth, GA

National Provider Directory

National Provider Directory

Locations

2148 Duluth Hwy
Duluth, GA 30097

2148 Duluth Hwy
Ste 102
Duluth, GA 30097
Phone (770) 817-3990

2320 Peachtree Industrial Blvd
Ste 104
Duluth, GA 30097

Practitioners & affiliated clinicians

Practitioners 2

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": "1298419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298419200000",
    "number": "1619274941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2148 DULUTH HWY STE 102",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300974504",
            "telephone_number": "770-817-3990",
            "fax_number": "770-817-3991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2148 DULUTH HWY STE 102",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300974504",
            "telephone_number": "770-817-3990",
            "fax_number": "770-817-3991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHEL EYECARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-23",
        "last_updated": "2011-02-23",
        "status": "A",
        "authorized_official_last_name": "CHA",
        "authorized_official_first_name": "SUSIE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "770-817-3990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "2370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2011; 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.