NPIMap

Organization Active NPI

Caudelle & Wilson Eye Care LLC

  • Optometrist
  • Fayetteville, GA
National Provider Identifier
1831514538
Registry record updated Mar 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
GA800 Issued in GA
Legal business name
CAUDELLE & WILSON EYE CARE LLC
Practice address
320 N Jeff Davis Drive
Suite a
Fayetteville, GA 30021
Phone
(770) 461-2144
Fax
(770) 461-5792
NPI assigned
Mar 4, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2014

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

Authorized official

Name
Michael E Wilson, OD
Title
Optometrist/Owner
Phone
(770) 461-2144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X GA800 GA Primary

Addresses

Primary practice location

320 N Jeff Davis Drive
Suite a
Fayetteville, GA 30021

Mailing address

320 N Jeff Davis Dr Ste a
Fayetteville, GA 30214-1669
Phone (770) 461-2144

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1393891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393891200000",
    "number": "1831514538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 N JEFF DAVIS DR STE A",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141669",
            "telephone_number": "770-461-2144",
            "fax_number": "770-461-5792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 N JEFF DAVIS DRIVE",
            "address_2": "SUITE A",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "30021",
            "telephone_number": "770-461-2144",
            "fax_number": "770-461-5792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAUDELLE & WILSON EYE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-04",
        "last_updated": "2014-03-04",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "770-461-2144",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "GA800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2014; 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.