NPIMap

Organization Active NPI

Marietta Eye Clinic PA

  • Ophthalmology Physician
  • Suwanee, GA
National Provider Identifier
1700675568
Registry record updated May 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MARIETTA EYE CLINIC PA
Practice address
4025 Johns Creek Pkwy Ste 200
Suwanee, GA 30024-5683
Phone
(678) 439-2450
NPI assigned
May 6, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2025

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

Authorized official

Name
Brian Rasmus
Title
VP, Cfo TPR
Phone
(469) 893-2532

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

4025 Johns Creek Pkwy Ste 200
Suwanee, GA 30024-5683

Mailing address

PO Box 96837
Charlotte, NC 28296-6837
Phone (678) 439-2450

Other names 1

  • Marietta Eye Clinic Johns Creek Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040518000057 GA Part B Supplier - Clinic/Group Practice 0143210427 Receives reassigned benefits from 46 practitioners
14 other NPIs on this enrollment
Practice locations: Woodstock, GA; Villa Rica, GA; Suwanee, GA; Roswell, GA; Marietta, GA; Acworth, GA; Canton, GA; Cartersville, GA…

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Cartersville Eye Clinic17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Practitioners & affiliated clinicians

Practitioners 49

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

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1746489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746489600000",
    "number": "1700675568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 96837",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282966837",
            "telephone_number": "678-439-2450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4025 JOHNS CREEK PKWY STE 200",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300245683",
            "telephone_number": "678-439-2450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA EYE CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-06",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-06",
        "status": "A",
        "authorized_official_last_name": "RASMUS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "VP, CFO TPR",
        "authorized_official_telephone_number": "469-893-2532"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marietta Eye Clinic Johns Creek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Suwanee, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2025; 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.