Pediatric Vision Development Center of Forsyth

Primary specialty

Vision Therapy OptometristTaxonomy code 152WV0400X

License

2353 Issued in GA

Legal business name

PEDIATRIC VISION DEVELOPMENT CENTER OF FORSYTH

Practice address

2920 Ronald Reagan Blvd
Ste 104
Cumming, GA 30041-6206

Phone

(770) 904-0979

NPI assigned

Jul 30, 2014

Last updated

Jul 30, 2014By 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. Joseph Rouw, ODNPI 1497753701

Title

Owner

Phone

(678) 448-2854

Specialties & licenses 1

Addresses

Locations

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.

• Joseph Rouw, OD, FAAO, FCOVD

  • Optometrist
  • Dacula, GA
  • NPI 1497753701
  NPD (past) Authorized official
• Nadira Soad Shadeed, O.D., F.C.O.V.D.

  • Vision Therapy Optometrist
  • Dacula, GA
  • NPI 1952411969
  NPD (past)

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

{
    "created_epoch": "1406678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406678400000",
    "number": "1659789923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3452 LAKE MILL RD",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305195349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 RONALD REAGAN BLVD",
            "address_2": "STE 104",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300416206",
            "telephone_number": "770-904-0979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC VISION DEVELOPMENT CENTER OF FORSYTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-30",
        "last_updated": "2014-07-30",
        "status": "A",
        "authorized_official_last_name": "ROUW",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-448-2854",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "GA",
            "license": "2353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peachtree Orthoapedic Clinic, P.a.
• Peachtree Orthopaedic Clinic, PC
• Peachtree Orthopaedic Surgery Center-North, LLC
• Callie Michelle Peck, NP
• Pediatric Health Care of North Georgia, PC
• Rochelle Peet, LPC
• Gustave Joseph Peluso III, DMD
• Louisa Peluso, LCSW
• Pendley Business Ventures, Inc. (LEAP Pediatric Therapy Services)
• Julia Nicole Pendley, DPT

• Vision Therapy Optometrist in Cumming, GA
• Providers in Cumming, GA by specialty
• Vision Therapy Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2014; 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.