Loganville Eyecare, PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT001189 Issued in GA

Legal business name

LOGANVILLE EYECARE, PC

Practice address

4495 Atlanta Hwy
Suite 300
Loganville, GA 30052-6736

Phone

(770) 554-3456

NPI assigned

May 19, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Alvin Lewis Frey, OD

Title

President

Phone

(770) 554-3456

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lewis Frey, OD, PC Former legal business name

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

{
    "created_epoch": "1337385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537833600000",
    "number": "1962762328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4495 ATLANTA HWY",
            "address_2": "SUITE 300",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300526736",
            "telephone_number": "770-554-3456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4495 ATLANTA HWY",
            "address_2": "SUITE 300",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300526736",
            "telephone_number": "770-554-3456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGANVILLE EYECARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-19",
        "last_updated": "2018-09-25",
        "status": "A",
        "authorized_official_last_name": "FREY",
        "authorized_official_first_name": "ALVIN",
        "authorized_official_middle_name": "LEWIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-554-3456",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT001189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00716185B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lewis Frey, OD, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Optometrist in Loganville, GA
• Providers in Loganville, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; 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.