MEDICARE: GA DOCTORS OF OPTOMETRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1073195780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GA DOCTORS OF OPTOMETRY LLC

Provider Business Mailing Address
First Line	:	19100 RIDGEWOOD PKWY BLD 1 7TH FLOOR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-1834
Country	:	US
Telephone Number	:	726-444-4078
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 ERNEST W BARRETT PKWY NW STE 21
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-4918
Country	:	US
Telephone Number	:	770-429-1660
Fax Number	:	770-429-5509

Authorized Official
Title or Position	:	OWNER
Name	:	MATTHEW MARSICH
Credential	:	OD
Telephone Number	:	726-444-4078

Provider Enumeration Date	:	04/22/2021
Last Update Date	:	03/10/2026

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