Healthcare Provider Details

I. General information

NPI: 1548194731
Provider Name (Legal Business Name): ONEOPTO GA 2 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1192 DOGWOOD DR SE
CONYERS GA
30012-5454
US

IV. Provider business mailing address

1192 DOGWOOD DR SE
CONYERS GA
30012-5454
US

V. Phone/Fax

Practice location:
  • Phone: 770-860-1919
  • Fax: 770-860-1607
Mailing address:
  • Phone: 770-860-1919
  • Fax: 770-860-1607

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: PRESIDENT
Credential:
Phone: 770-860-1919