{"npi":"1487641858","type":"NPI-2","status":"active","name":{"display":"Northeast Georgia Vision Care LLC","other":[],"organization_name":"NORTHEAST GEORGIA VISION CARE LLC","authorised_official":"Holton King"},"specialty":{"primary_taxonomy":"152W00000X","primary_taxonomy_description":"Optometrist","slug":"optometrist","schema_org_specialty":null,"all":[{"code":"152W00000X","description":"Optometrist","primary":true,"state":"GA","license":"1106"}]},"addresses":[{"purpose":"LOCATION","street_1":"118 VISION DR","city":"CORNELIA","state":"GA","postal_code":"305315737","country_code":"US","phone":"7067766311","fax":"7067767243"},{"purpose":"MAILING","street_1":"118 VISION DR","city":"CORNELIA","state":"GA","postal_code":"305315737","country_code":"US","phone":"7067766311","fax":"7067767243"}],"license":{"state":"GA","number":"1106"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"00515545B","state":"GA","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20100930047524","type_code":"30-41","type_desc":"DME SUPPLIER - PHYSICIAN - OPTOMETRIST","state":"GA","pac_id":"7416055603"}]},"enumeration_date":"2005-09-30","last_updated":"2023-09-25","_meta":{"source":"NPPES","snapshot_date":"2023-09-25","doc_url":"https://findmynpi.com/api"}}