NPIMap

Organization Active NPI

Marietta Eye Optical Inc

  • Ophthalmology Physician
  • Villa Rica, GA
National Provider Identifier
1982392312
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MARIETTA EYE OPTICAL INC
Practice address
209 Cooley Way
Suite 201
Villa Rica, GA 30180-7057
Phone
(770) 427-8111
NPI assigned
Apr 25, 2023
Organization subpart
Yes
Parent organization
MARIETTA EYE OPTICAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

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

Authorized official

Name
Henry Elliott Gatehouse
Title
Director
Phone
(770) 427-8111

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

209 Cooley Way
Suite 201
Villa Rica, GA 30180-7057

Mailing address

PO Box 63328
Charlotte, NC 28263-3328
Phone (770) 427-8111

National Provider Directory

National Provider Directory
Tax ID family
Cherry Street Optical8 organizations share this tax ID, including this one
Part of
Cherry Street Optical

Other organizations with this tax ID 7

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": "1682380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682380800000",
    "number": "1982392312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 63328",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282633328",
            "telephone_number": "770-427-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 COOLEY WAY",
            "address_2": "SUITE 201",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301807057",
            "telephone_number": "770-427-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA EYE OPTICAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARIETTA EYE OPTICAL INC",
        "enumeration_date": "2023-04-25",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A",
        "authorized_official_last_name": "GATEHOUSE",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "ELLIOTT",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "770-427-8111"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Villa Rica, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2023; 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.