East Georgia Eyecare LLC
Organization Active NPI Optometrist · Conyers, GA
NPI 1811024045 · NPPES record last updated Jul 31, 2024
Key facts
- NPI
- 1811024045
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- EAST GEORGIA EYECARE LLC
- Practice address
- 1192 Dogwood Dr SE
Conyers, GA 30012-5454 - Phone
- (770) 860-1919
- Fax
- (770) 860-1607
- NPI assigned
- Feb 27, 2007
- Organization subpart
- No
Authorized official
- Name
- David L Grosswald, OD
- Title
- President
- Phone
- (770) 860-1919
Practitioners 8
-
Chris J Coffini, OD
-
David L Grosswald, O.D.
-
Brian Robert Healey, O.D.
-
William Patrick Parks, O.D.
-
Brian C Dempsey, O.D.
-
Kathy Ann Samuels, O.D.
-
Regina Hamlin, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040520000835 | GA | Part B Supplier - Clinic/Group Practice | 7618968413 |
Receives reassigned benefits from 4 practitioners Practice locations: Conyers, GA |
National Provider Directory
Locations
255B Robert C Daniel Jr Pkwy
Augusta, GA 30909
Phone (706) 481-9700
1315 Dogwood Dr SE
Ste B
Conyers, GA 30013
Phone (770) 860-1919
7210 Stonecrest Pkwy
Lithonia, GA 30038
Phone (770) 482-4008
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
1192 Dogwood Dr SE
Conyers, GA 30012-5454
Mailing address
1192 Dogwood Dr.
Conyers, GA 30012-5454
Phone (770) 860-1919
Other names
- EAST GEORGIA EYECARE, PC
Other providers in Conyers, GA
- Jeffrey Alan Easley
- East Atlanta Cardiology LLC
- East Atlanta Endodontics & Microsurgery, PC
- East Atlanta Endoscopy Centers, LLC
- East Conyers Behavioral Health Clinic
- East Metro Emt Services LLC
- East Metro Internal Medicine
- East Metro Wellness Center, LLC
- Eastern Health Center PC
- Eastmetro Eyecare P.C.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.