Georgia Optical

Primary specialty

OptometristTaxonomy code 152W00000X

License

001439 Issued in GA

Legal business name

GEORGIA OPTICAL

Practice address

3173 E 1St St
Vidalia, GA 30474-8830

Phone

(912) 246-4703

NPI assigned

Mar 13, 2012

Last updated

Mar 26, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Alan Wrenn

Title

Ceo

Phone

(912) 537-0767

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1331596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332720000000",
    "number": "1811262678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3173 E 1ST ST",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304748830",
            "telephone_number": "912-246-4703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3173 E 1ST ST",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304748830",
            "telephone_number": "912-246-4703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-13",
        "last_updated": "2012-03-26",
        "status": "A",
        "authorized_official_last_name": "WRENN",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-537-0767",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "001439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Georgia Eye Institute of the Southeast, LLC
• Georgia Eye Institute of the Southeast, LLC
• Georgia Eye Institute, Inc.
• Georgia Eye Institute, Inc.
• Georgia Hyperbaric and Wound Consulting, LLC
• Georgia Palliative Care Inc. (Solace Hospice)
• Frank Gibase, M.D.
• Gilbert J. Gonzalez, M.D., LLC
• Paul Joseph Giles, M.D.
• Carley Gillis

• Optometrist in Vidalia, GA
• Providers in Vidalia, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.