Healthcare Provider Details

I. General information

NPI: 1366498214
Provider Name (Legal Business Name): JAMES L PURVIS O. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/10/2023
Certification Date: 09/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 OZORA RD
LAWRENCEVILLE GA
30045-6650
US

IV. Provider business mailing address

844 OZORA RD
LAWRENCEVILLE GA
30045-6650
US

V. Phone/Fax

Practice location:
  • Phone: 678-643-6116
  • Fax:
Mailing address:
  • Phone: 678-643-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT000866
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: