NPIMap

Organization Active NPI

Pediatric Vision Development Center of Gwinnett

  • Vision Therapy Optometrist
  • Dacula, GA
National Provider Identifier
1669880936
Registry record updated Aug 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vision Therapy OptometristTaxonomy code 152WV0400X
License
2355 Issued in GA
Legal business name
PEDIATRIC VISION DEVELOPMENT CENTER OF GWINNETT
Practice address
2055 Hamilton Creek Pkwy
Ste 120
Dacula, GA 30019-7204
Phone
(770) 904-0979
NPI assigned
Jul 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2016

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

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
Vision Therapy OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152WV0400X 2355 GA Primary

Addresses

Primary practice location

2055 Hamilton Creek Pkwy
Ste 120
Dacula, GA 30019-7204

Mailing address

2055 Hamilton Creek Pkwy
Ste 120
Dacula, GA 30019-7204
Phone (770) 904-0979

National Provider Directory

National Provider Directory

Locations

2055 Hamilton Creek Pkwy
Ste 120
Dacula, GA 30019
Phone (770) 904-0979

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1406678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471824000000",
    "number": "1669880936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2055 HAMILTON CREEK PKWY",
            "address_2": "STE 120",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300197204",
            "telephone_number": "770-904-0979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 HAMILTON CREEK PKWY",
            "address_2": "STE 120",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300197204",
            "telephone_number": "770-904-0979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC VISION DEVELOPMENT CENTER OF GWINNETT",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-30",
        "last_updated": "2016-08-22",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": "GA",
            "license": "2355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dacula, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2016; 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.