NPIMap

Organization Active NPI

Johns Creek Eye Care LLC

  • Optometrist
  • Duluth, GA
National Provider Identifier
1720559362
Registry record updated Dec 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
JOHNS CREEK EYE CARE LLC
Practice address
10360 Medlock Bridge Rd
Duluth, GA 30097-5927
Phone
(770) 476-1220
NPI assigned
Dec 7, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2018

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

Authorized official

Name
Dr. Rupesh Bhakta, ODNPI 1952616930
Title
Optometrist
Phone
(314) 435-6584

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
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

10360 Medlock Bridge Rd
Duluth, GA 30097-5927

Mailing address

7625 Stamp Mill CT
Johns Creek, GA 30097-2406
Phone (314) 435-6584

Other names 1

  • Justice Vision Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200310002847 GA Part B Supplier - Clinic/Group Practice 2163850934 Receives reassigned benefits from 3 practitioners
Practice locations: Duluth, GA

National Provider Directory

National Provider Directory

Locations

10360 Medlock Bridge Rd
Johns Creek, GA 30097
Phone (770) 476-1220

10360 Medlock Bridge Rd
Ste A1
Johns Creek, GA 30097
Phone (770) 476-1220

Practitioners & affiliated clinicians

Practitioners 5

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": "1544140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544140800000",
    "number": "1720559362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7625 STAMP MILL CT",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300972406",
            "telephone_number": "314-435-6584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10360 MEDLOCK BRIDGE RD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300975927",
            "telephone_number": "770-476-1220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNS CREEK EYE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-07",
        "last_updated": "2018-12-07",
        "status": "A",
        "authorized_official_last_name": "BHAKTA",
        "authorized_official_first_name": "RUPESH",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "314-435-6584",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Justice Vision Clinic",
            "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 Dec 7, 2018; 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.