NPIMap

Organization Active NPI

Mel Optical LLC

Doing business as My EyeLab

  • Optometrist
  • Duluth, GA
National Provider Identifier
1679103048
Registry record updated Feb 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MEL OPTICAL LLC
Doing business as
My EyeLab
Practice address
1943 Pleasant Hill Rd
Duluth, GA 30096-4625
Phone
(561) 275-2020
Fax
(561) 828-8367
NPI assigned
Jan 24, 2020
Last updated
Feb 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2021

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

Authorized official

Name
Jackie Bennett
Title
Credentialing Supervisor
Phone
(561) 433-6009

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary
Eyewear Supplier 332H00000X

Addresses

Primary practice location

1943 Pleasant Hill Rd
Duluth, GA 30096-4625

Mailing address

1943 Pleasant Hill Rd
Duluth, GA 30096-4625

Other names 1

  • My EyeLab Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mel Optical LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1579824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613606400000",
    "number": "1679103048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1943 PLEASANT HILL RD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300964625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1943 PLEASANT HILL RD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300964625",
            "telephone_number": "561-275-2020",
            "fax_number": "561-828-8367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEL OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-24",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "561-433-6009"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My EyeLab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 18, 2021; 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.