Rafael Antonio Gamba Jr., OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT003130 Issued in GA

Practice address

112A Riverstone Pkwy
Canton, GA 30114-2448

Phone

(770) 874-2020

Fax

(470) 785-2795

NPI assigned

Nov 9, 2018

Last updated

Sep 21, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Optometry

Education

International American University at Puerto Rico - School of Optometry, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Myeyedr Optometry of Georgia, LLCGroup PAC ID 8224261201, 100 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rafael.gamba@uprisedirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Myeyedr Optometry of Georgia, LLC

  dba MyEyeDr.

  • Optometrist
  • Rincon, GA
  • NPI 1437294592
  Medicare reassignment Care Compare group NPD
• Happy Eyes LLC

  dba Happy Eyes

  • Optometrist
  • Canton, GA
  • NPI 1104430537
  Authorized official Same address or phone
• Myeyedr Optometry of Georgia, LLC

  dba MyEyeDr.

  • Optometrist
  • Savannah, GA
  • NPI 1164549366
  NPD
• Myeyedr Optometry of Georgia, LLC

  dba MyEyeDr.

  • Optometrist
  • Tyrone, GA
  • NPI 1275326571
  NPD
• Myeyedr Optometry of Georgia, LLC

  dba MyEyeDr.

  • Optometrist
  • Woodstock, GA
  • NPI 1144684184
  NPD (past)
• Luxottica of America Inc

  dba Lenscrafters #E895

  • Eyewear Supplier
  • Kansas City, MO
  • NPI 1497412522
  NPD (past)

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

{
    "created_epoch": "1541721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632182400000",
    "number": "1629546437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4398",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301140017",
            "telephone_number": "770-874-2020",
            "fax_number": "470-785-2795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112A RIVERSTONE PKWY",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301142448",
            "telephone_number": "770-874-2020",
            "fax_number": "470-785-2795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBA",
        "first_name": "RAFAEL",
        "middle_name": "ANTONIO",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-09",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT003130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Frisbee, PA
• Brenda Gail Fritz, DMD
• Stephen Fuchs, PT
• Function Forward Physical Therapy
• Ga Doctors of Optometry LLC
• Christine Gangwisch, MSN, APRN, WHNP-BC
• Ayisha Gani, M.D.
• Karim Gani, M.D.
• Erinn L Gardner, MD
• Kristin Garncarz

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.