NPIMap

Organization Active NPI

Modern Eyes of Georgia, LLC

  • Optometrist
  • Buford, GA
National Provider Identifier
1982831756
Registry record updated Mar 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2009019277 Issued in GA
Legal business name
MODERN EYES OF GEORGIA, LLC
Practice address
3420 Buford Dr
Suite C560
Buford, GA 30519-4990
Phone
(770) 831-7200
Fax
(770) 831-0076
NPI assigned
Jun 18, 2009
Last updated
Mar 29, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2010

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

Authorized official

Name
Dr. David William Dudovitz, O.D.
Title
Ceo
Phone
(770) 831-1010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2009019277 GA Primary

Addresses

Primary practice location

3420 Buford Dr
Suite C560
Buford, GA 30519-4990

Mailing address

800 Mount Vernon Hwy NE Ste 120
Atlanta, GA 30328-4293
Phone (770) 804-1684

National Provider Directory

National Provider Directory

Locations

3385 Woodward Crossing Blvd
Ste 350
Buford, GA 30519
Phone (770) 831-1010

3420 Buford Dr
Ste C560
Buford, GA 30519
Phone (770) 831-1010

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1245283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269820800000",
    "number": "1982831756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 MOUNT VERNON HWY NE STE 120",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303284293",
            "telephone_number": "770-804-1684",
            "fax_number": "770-804-1679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3420 BUFORD DR",
            "address_2": "SUITE C560",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305194990",
            "telephone_number": "770-831-7200",
            "fax_number": "770-831-0076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN EYES OF GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-18",
        "last_updated": "2010-03-29",
        "status": "A",
        "authorized_official_last_name": "DUDOVITZ",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-831-1010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "2009019277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buford, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2010; 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.