=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053260463
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONEOPTO GA 1 PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2026
-----------------------------------------------------
Last Update Date | 01/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9995 JONES BRIDGE RD
-----------------------------------------------------
City | JOHNS CREEK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30022-6519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-475-1242
-----------------------------------------------------
Fax | 678-366-1344
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9995 JONES BRIDGE RD
-----------------------------------------------------
City | JOHNS CREEK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30022-6519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-475-1242
-----------------------------------------------------
Fax | 678-366-1344
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAVID GROSSWALD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-860-1919
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------