Legacy Family Eyecare Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT001092 Issued in GA

Legal business name

LEGACY FAMILY EYECARE INC

Practice address

210 Hudson St
Cumming, GA 30040-2432

Phone

(770) 887-9171

Fax

(770) 887-9180

NPI assigned

Oct 3, 2011

Organization subpart

No

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

Authorized official

Name

Michael Roberts, ODNPI 1578654265

Title

Owner

Phone

(770) 887-9171

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 5

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

• Michael Roberts, OD

  • Optometrist
  • Cumming, GA
  • NPI 1578654265
  Medicare reassignment Care Compare group NPD Authorized official
• Tiffany Luke, O.D.

  • Optometrist
  • Cumming, GA
  • NPI 1780050526
  Medicare reassignment Care Compare group NPD
• Matthew B. Kaufman, M.D.

  • Ophthalmology Physician
  • Cumming, GA
  • NPI 1871600353
  NPD (past)
• Phuongthao Minh Truong, O.D.

  • Optometrist
  • Cumming, GA
  • NPI 1548356470
  NPD (past)
• Brian Tribunella, OD

  • Optometrist
  • Wesley Chapel, FL
  • NPI 1285789156
  NPD (past)

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

{
    "created_epoch": "1317600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554422400000",
    "number": "1689958183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 HUDSON ST",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300402432",
            "telephone_number": "770-887-9171",
            "fax_number": "770-887-9180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 HUDSON ST",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300402432",
            "telephone_number": "770-887-9171",
            "fax_number": "770-887-9180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY FAMILY EYECARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-03",
        "last_updated": "2019-04-05",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-887-9171",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT001092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00324816A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lucrecia Marie Lee, CRNA
• Seth Lee, APRN
• Larissa Dawn Leffers, LPC
• Jade Leffingwell, PT, DPT
• Stephanie Maxine Lefler, CSFA
• Rachel C Lentz
• Lori Beth Lenz
• Stephen Alexander Leo, PT, DPT
• Gelsie F Lessig, RD,LD
• Derek Leung, RPH

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.