Individual provider Active NPI

Lauren Haynie Grahl, O.D.

  • Optometrist
  • Perry, GA
National Provider Identifier
1962637603
Registry record updated May 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT002528 Issued in GA
Practice address
1105 Morningside Dr
Perry, GA 31069-2905
Phone
(478) 987-2020
Fax
(478) 988-4628
NPI assigned
May 26, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 8, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT002528 GA Primary

Addresses

Primary practice location

1105 Morningside Dr
Perry, GA 31069-2905

Mailing address

1105 Morningside Dr
Perry, GA 31069-2905
Phone (478) 987-2020

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20090817000416 GA Practitioner - Optometry 4789738378

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT002528GAMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1243296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336435200000",
    "number": "1962637603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 MORNINGSIDE DR",
            "city": "PERRY",
            "state": "GA",
            "postal_code": "310692905",
            "telephone_number": "478-987-2020",
            "fax_number": "478-988-4628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 MORNINGSIDE DR",
            "city": "PERRY",
            "state": "GA",
            "postal_code": "310692905",
            "telephone_number": "478-987-2020",
            "fax_number": "478-988-4628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHL",
        "first_name": "LAUREN",
        "middle_name": "HAYNIE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-26",
        "last_updated": "2012-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perry, GA

Sources for this page

Verify at the official NPI Registry.