Carlos E. Pessoa, OD, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

002495 Issued in GA

Legal business name

CARLOS E. PESSOA, OD, LLC

Practice address

1498 Merchants Dr
Dallas, GA 30132-5064

Phone

(770) 445-2715

Fax

(770) 445-5805

NPI assigned

Feb 21, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Carlos Eduardo Pessoa, O.D.

Title

Owner/Ceo

Phone

(770) 445-2715

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1487635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487635200000",
    "number": "1891234076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1498 MERCHANTS DR",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301325064",
            "telephone_number": "770-445-2715",
            "fax_number": "770-445-5805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1498 MERCHANTS DR",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301325064",
            "telephone_number": "770-445-2715",
            "fax_number": "770-445-5805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLOS E. PESSOA, OD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-21",
        "last_updated": "2017-02-21",
        "status": "A",
        "authorized_official_last_name": "PESSOA",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_middle_name": "EDUARDO",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "770-445-2715",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "002495",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "GA",
            "license": "002495",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": "GA",
            "license": "002495",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": "GA",
            "license": "002495",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Dallas, GA
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• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2017; 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.