Healthcare Provider Details

I. General information

NPI: 1699624007
Provider Name (Legal Business Name): ONEOPTO GA 1 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 BROOKHAVEN AVE NE STE 1110
BROOKHAVEN GA
30319-3253
US

IV. Provider business mailing address

305 BROOKHAVEN AVE NE STE 1110
BROOKHAVEN GA
30319-3253
US

V. Phone/Fax

Practice location:
  • Phone: 404-816-8889
  • Fax: 404-816-8890
Mailing address:
  • Phone: 404-816-8889
  • Fax: 404-816-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DAVID GROSSWALD
Title or Position: OWNER
Credential:
Phone: 770-860-1919