K D M VISION CENTER INC (NPI# 1588788293) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588788293 |
| Entity Type | Organization |
| Organization Name | K D M VISION CENTER INC |
| Other Organization Name | PEARLE VISION |
| Practice Address |
2150 E Walnut Ave Ste 10 Dalton GA 30721-4500 |
| Mailing Address |
4413 Arbor Trl Cohutta GA 30710-9323 |
| Practice Telephone | 7062262722 |
| Practice Fax Number | 7062756114 |
| Mailing Telephone | 7066942020 |
| Mailing Fax Number | 2062756114 |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2013-10-09 |
| Authorized Official Name | MR. KIRK D MALERBI (OWNERPRESIDENT) |
| Authorized Official Telephone | 7062262722 |
| Authorized Official Credential | LDO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152W00000X | Optometrist | 1838 | GA | Eye and Vision Services Providers |
| Y | 156FX1800X |
Technician/Technologist Specialization: Optician |
GA1605 | GA | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | LISCENSED DISPENSING OPTI | GA1605 | 01 |
| Other Name | Type Code |
|---|---|
| PEARLE VISION | Doing Business As Name - Organization |
| Street Address |
2150 E WALNUT AVE STE 10 |
| City | DALTON |
| State | GA |
| Zip Code | 30721-4500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760608905 | Rex Karl Gross | Optometrist | 2150 E Walnut Ave, Ste. 10&11, Dalton, GA 30721-4500 | 2007-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417322942 | Alison Gobel | Case Manager/Care Coordinator | 2611 Clevland Hwy, Dalton, GA 30721 | 2015-12-09 |
| 1528433026 | Crystal Sparks | Case Manager/Care Coordinator | 2611 Cleveland Highway, Dalton, GA 30721 | 2015-12-09 |
| 1043524838 | Quality Care Concepts, Inc. | Durable Medical Equipment & Medical Supplies | 121 Tilton Road, Dalton, GA 30721 | 2010-08-04 |
| 1538490081 | Jennifer Sawyer | Counselor | 720 S. Glenwood Ave, Ste 112, Dalton, GA 30721 | 2010-01-22 |
| 1831210673 | Linda E. Minter | Case Manager/Care Coordinator | 932 Williams Rd. Nw, Dalton, GA 30721 | 2007-04-02 |
| 1265595318 | M Edwin Caylor Dds PC | Dentist | 2880 Cleveland Hwy, Dalton, GA 30721 | 2006-12-19 |
| 1295823003 | Candler Road Dental, PC | Dentist | 2107 E. Walnut Ave., Dalton, GA 30721 | 2006-10-10 |
| 1508872466 | Family Walk-in Clinic | Family Medicine | 1100 E Walnut Avenue, Suite 14 & 15, Dalton, GA 30721 | 2006-07-31 |
| 1225056823 | James L Coone | Family Medicine | 1100 E. Walnut Avenue, Suite 14 & 15, Dalton, GA 30721 | 2006-07-18 |
| 1770517591 | The Kroger Co | Durable Medical Equipment & Medical Supplies | 1205 N Glenwood Road, Dalton, GA 30721 | 2006-07-10 |
| Find all providers in zip 30721 | ||||
| Taxonomy Code | 156FX1800X |
| Grouping | Eye and Vision Services Providers |
| Classification | Technician/Technologist |
| Specialization | Optician |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700088275 | Kimberly Lynn Bates | Technician/Technologist | 1240 N Thornton Ave, Dalton, GA 30720-3605 | 2007-06-05 |
| 1972689768 | Wal-mart Stores East, Lp | Technician/Technologist | 815 Shugart Rd, Dalton, GA 30720-2433 | 2006-10-27 |
| 1811078520 | Wal-mart Stores East, Lp | Technician/Technologist | 2545 E Walnut Ave, Dalton, GA 30721-8799 | 2006-10-18 |
| 1033121660 | Marilyn Ball Johnson | Technician/Technologist | 1805 E Walnut Ave, Dalton, GA 30721-4338 | 2006-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427667302 | Carole F Medou | Technician/Technologist | 57 Hurricane Shoals Rd Nw Ste A, Lawrenceville, GA 30046-5396 | 2020-07-28 |
| 1255966206 | Steven W Burton | Technician/Technologist | 2498 Wingfield Dr, Austell, GA 30106-1762 | 2020-03-10 |
| 1477185205 | Dale A Klauss | Technician/Technologist | 294 Kenwood Rd Ste A, Fayetteville, GA 30214-3451 | 2020-02-10 |
| 1104380682 | National Vision Inc | Technician/Technologist | 97 Parkway Dr, Fort Oglethorpe, GA 30742-4249 | 2019-01-29 |
| 1134683600 | National Vision Inc | Technician/Technologist | 3159 Highway 278 Ne, Covington, GA 30014-2301 | 2019-01-29 |
| 1255818993 | Kerryn Castellon | Technician/Technologist | 55 Sudderth St, Buford, GA 30518-3335 | 2018-07-25 |
| 1770075731 | National Vision, Inc. | Technician/Technologist | 916 Loganville Hwy Ste 300, Bethlehem, GA 30620-2145 | 2018-06-05 |
| 1598262487 | National Vision, Inc. | Technician/Technologist | 534 Marketplace Pkwy Ste 740, Dawsonville, GA 30534-7549 | 2018-04-09 |
| 1720582992 | Amos D Washington | Technician/Technologist | 10269 Industrial Blvd Ne, Covington, GA 30014-1485 | 2018-03-21 |
| 1619490489 | Lisa Stonebraker | Technician/Technologist | 105 E Main St Ste 116, Woodstock, GA 30188-5013 | 2017-07-24 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on K D M VISION CENTER INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.