Active NPI
Simon Vincenzo Guzman, LDO
- Optician
- Athens, GA
National Provider Identifier
1790509644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- LDO003009
- Practice address
- 450 Jessica Way
Athens, GA 30606-1393 - Phone
- (626) 226-6992
- NPI assigned
- Nov 7, 2024
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contact Lens Technician/Technologist | 156FC0800X | LDO003009 | GA | |
| Ophthalmic Technician/Technologist | 156FX1100X | |||
| Optician | 156FX1800X | LDO003009 | GA | Primary |
Addresses
Primary practice location
450 Jessica Way
Athens, GA 30606-1393
Mailing address
450 Jessica Way
Athens, GA 30606-1393
Phone (626) 226-6992
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LDO003009 | GA | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730937600000",
"number": "1790509644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 JESSICA WAY",
"city": "ATHENS",
"state": "GA",
"postal_code": "306061393",
"telephone_number": "626-226-6992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 JESSICA WAY",
"city": "ATHENS",
"state": "GA",
"postal_code": "306061393",
"telephone_number": "626-226-6992"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUZMAN",
"first_name": "SIMON",
"middle_name": "VINCENZO",
"credential": "LDO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-11-07",
"last_updated": "2024-11-07",
"certification_date": "2024-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "156FC0800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Contact Lens",
"state": "GA",
"license": "LDO003009",
"primary": false
},
{
"code": "156FX1100X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Ophthalmic",
"state": null,
"license": null,
"primary": false
},
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "GA",
"license": "LDO003009",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Athens, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.