NPIMap

Organization Active NPI

Fayette Medical Clinic Optical Shop

  • Ophthalmology Physician
  • Fayetteville, GA
National Provider Identifier
1891910618
Registry record updated Jun 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
20001558 Issued in GA
Legal business name
FAYETTE MEDICAL CLINIC OPTICAL SHOP
Practice address
101 Yorktown Dr Ste 225
Fayetteville, GA 30214-1568
Phone
(770) 460-2331
Fax
(770) 460-4016
NPI assigned
Apr 16, 2007
Last updated
Jun 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2021

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

Authorized official

Name
Mr. Rick Rodecker
Title
Administrator
Phone
(404) 351-2220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 20001558 GA Primary

Addresses

Primary practice location

101 Yorktown Dr Ste 225
Fayetteville, GA 30214-1568

Mailing address

101 Yorktown Dr Ste 225
Fayetteville, GA 30214-1568
Phone (770) 460-2331

National Provider Directory

National Provider Directory
Tax ID family
Eye Consultants of Atl2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622678400000",
    "number": "1891910618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 YORKTOWN DR STE 225",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141568",
            "telephone_number": "770-460-2331",
            "fax_number": "770-460-4016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 YORKTOWN DR STE 225",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141568",
            "telephone_number": "770-460-2331",
            "fax_number": "770-460-4016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTE MEDICAL CLINIC OPTICAL SHOP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A",
        "authorized_official_last_name": "RODECKER",
        "authorized_official_first_name": "RICK",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "404-351-2220",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "GA",
            "license": "20001558",
            "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 Jun 3, 2021; 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.