B.Spectacled-Suwanee

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT002878 Issued in GA

Legal business name

B.SPECTACLED-SUWANEE

Practice address

991 Peachtree Industrial Blvd Ste 114
Suwanee, GA 30024-4343

Phone

(770) 904-0883

Fax

(678) 765-0976

NPI assigned

Aug 3, 2018

Organization subpart

No

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

Authorized official

Name

James Dykeman

Title

President

Phone

(404) 386-0295

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

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

• Marina L. Gurvich, O.D.

  • Optometrist
  • Suwanee, GA
  • NPI 1275819849
  Medicare reassignment NPD

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

{
    "created_epoch": "1533254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1720566557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "991 PEACHTREE INDUSTRIAL BLVD STE 114",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244343",
            "telephone_number": "770-904-0883",
            "fax_number": "678-765-0976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "991 PEACHTREE INDUSTRIAL BLVD STE 114",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244343",
            "telephone_number": "770-904-0883",
            "fax_number": "678-765-0976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "B.SPECTACLED-SUWANEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-03",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "DYKEMAN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-386-0295"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; 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.