NPIMap

Organization Active NPI

Map Eyes LLC

Doing business as Eyes On Providence

  • Optometrist
  • Marietta, GA
National Provider Identifier
1750654141
Registry record updated Mar 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MAP EYES LLC
Doing business as
Eyes On Providence
Practice address
3535 Roswell Rd
Suite 8
Marietta, GA 30062-8826
Phone
(678) 560-8065
NPI assigned
Feb 15, 2012
Last updated
Mar 7, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2012

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

Authorized official

Name
Dr. Mital Patel, O.D.NPI 1760715361
Title
Owner
Phone
(678) 560-8065

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
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

3535 Roswell Rd
Suite 8
Marietta, GA 30062-8826

Mailing address

3535 Roswell Rd
Suite 8
Marietta, GA 30062-8826
Phone (678) 560-8065

Other names 1

  • Eyes On Providence Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120209000190 GA Part B Supplier - Clinic/Group Practice 2062679624 Receives reassigned benefits from 4 practitioners
Practice locations: Marietta, GA

National Provider Directory

National Provider Directory

Locations

3535 Roswell Rd
Ste 8
Marietta, GA 30062
Phone (678) 560-8065

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1329264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331078400000",
    "number": "1750654141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 ROSWELL RD",
            "address_2": "SUITE 8",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300628826",
            "telephone_number": "678-560-8065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 ROSWELL RD",
            "address_2": "SUITE 8",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300628826",
            "telephone_number": "678-560-8065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAP EYES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-15",
        "last_updated": "2012-03-07",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "MITAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-560-8065",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyes On Providence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2012; 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.