Eye Shop, P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT 002244 Issued in GA

Legal business name

EYE SHOP, P.C.

Practice address

3621 Vinings Slope SE
Suite 4150
Atlanta, GA 30339-4107

Phone

(678) 525-6737

NPI assigned

Sep 25, 2009

Last updated

Sep 25, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Drew Provost, O.D.

Title

President

Phone

(678) 525-6737

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1253836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253836800000",
    "number": "1649504424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W PEACHTREE ST NW",
            "address_2": "UNIT 2315",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303083536",
            "telephone_number": "678-525-6737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3621 VININGS SLOPE SE",
            "address_2": "SUITE 4150",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303394107",
            "telephone_number": "678-525-6737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SHOP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-25",
        "last_updated": "2009-09-25",
        "status": "A",
        "authorized_official_last_name": "PROVOST",
        "authorized_official_first_name": "DREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-525-6737",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT 002244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.