Individual provider Active NPI

Niddhi Patel

  • Optometrist
  • Lawrenceville, GA
National Provider Identifier
1780480228
Registry record updated Jun 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT003665 Issued in GA
Practice address
875 Lawrenceville Suwanee Rd
Lawrenceville, GA 30043-8479
Phone
(770) 963-0370
NPI assigned
Feb 24, 2025
Last updated
Jun 16, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Optometrist 152W00000X OPT003665 GA Primary

Addresses

Primary practice location

875 Lawrenceville Suwanee Rd
Lawrenceville, GA 30043-8479

Mailing address

455 Oak Springs Dr
Lawrenceville, GA 30043-3540
Phone (229) 343-2361

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250630001234 GA Practitioner - Optometry 1658884036 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Georgia, LLCGroup PAC ID 8224261201, 100 clinicians

Practice addresses (Care Compare)

4875 Altama Ave
Brunswick, GA 31520-2912
Phone (912) 554-0010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT003665GAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Georgia, LLC Optometrist CurrentSince Jun 16, 2025 Accepting new patients
Myeyedr Optometry of Georgia, LLC Optometrist CurrentSince Jun 16, 2025 Accepting new patients
Myeyedr Optometry of Georgia, LLC Optometrist Current Accepting new patients
Total Vision Suwanee LLC Optometrist Past Accepting new patients

Locations

4875 Altama Ave
Brunswick, GA 31520
Phone (912) 554-0010

6555 Sugarloaf Pkwy
Ste 305
Duluth, GA 30097
Phone (773) 495-0937

875 Lawrenceville Suwanee Rd
Lawrenceville, GA 30043
Phone (770) 822-2199

875 Lawrenceville Suwanee Rd
Ste 560
Lawrenceville, GA 30043
Phone (770) 963-0370

1000 Peachtree Industrial Blvd
Ste 14
Suwanee, GA 30024
Phone (770) 271-0611

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1740355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750032000000",
    "number": "1780480228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 OAK SPRINGS DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300433540",
            "telephone_number": "229-343-2361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 LAWRENCEVILLE SUWANEE RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300438479",
            "telephone_number": "770-963-0370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "NIDDHI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-24",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT003665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.