Jennifer A Dattolo, O.D.

Primary specialty

Vision Therapy OptometristTaxonomy code 152WV0400X

License

001878 Issued in GA

Practice address

1075 Buckhead Xing
Suite 130
Woodstock, GA 30189-4262

Phone

(770) 702-5996

NPI assigned

Oct 3, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pennsylvania College of Optometry, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bella Ottica LLC

  • Optometrist
  • Woodstock, GA
  • NPI 1568811610
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465430400000",
    "number": "1962596627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 BUCKHEAD XING",
            "address_2": "SUITE 130",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301894262",
            "telephone_number": "770-702-5996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 BUCKHEAD XING",
            "address_2": "SUITE 130",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301894262",
            "telephone_number": "770-702-5996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DATTOLO",
        "first_name": "JENNIFER",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2016-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "GA",
            "license": "001878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Montakia Princess Dance, LAPC
• Andrew Scott Daniel, PMHNP
• Alexis Daniels
• Katherine Garretson Darnell
• Attri Datta, M.D.
• Alicia Gibson Davis, LPC
• Brent Joseph Davis, PT, DPT
• David C Davis
• Lena Evelyn Davis, ATC, LAT, MS
• Samantha Kelly Blake Davis

• Vision Therapy Optometrist in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Vision Therapy Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.