Active NPI
David L Grosswald, O.D.
- Optometrist
- Conyers, GA
National Provider Identifier
1770543720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT001327
- Practice address
- 1192 Dogwood Drive
Conyers, GA 30012-5454 - Phone
- (770) 860-1919
- Fax
- (770) 860-1607
- NPI assigned
- Mar 24, 2006
- Last updated
- Apr 27, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | GA1327 | GA | |
| Optometrist | 152W00000X | OPT001327 | GA | Primary |
Addresses
Primary practice location
1192 Dogwood Drive
Conyers, GA 30012-5454
Mailing address
1192 Dogwood Drive
Conyers, GA 30012-5454
Phone (770) 860-1919
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 628068295A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Southern College of Optometry, 1990
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
1192 Dogwood Dr SE
Conyers, GA 30012-5454
Phone (770) 860-1919
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| GA1327 | GA | MD | Optometrist |
| 1327 | GA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dawson Vision Center, Inc. | Optometrist | Past | Accepting new patients |
| Oneopto Ga 2 PLLC | Optometrist | Past | Accepting new patients |
| Optique at West Paces LLC | Optometrist | Past | Accepting new patients |
Organizations & group practices 17
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optometrist
- Conyers, GA
- NPI 1811024045
-
- Optometrist
- Dawsonville, GA
- NPI 1194983403
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272326400000",
"number": "1770543720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1192 DOGWOOD DRIVE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300125454",
"telephone_number": "770-860-1919",
"fax_number": "770-860-1607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1192 DOGWOOD DRIVE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300125454",
"telephone_number": "770-860-1919",
"fax_number": "770-860-1607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROSSWALD",
"first_name": "DAVID",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2010-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "GA",
"license": "GA1327",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "GA",
"license": "OPT001327",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "628068295A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conyers, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.