GWINNETT PEDIATRIC & ADULT EYE CENTER
NPI 1578210589
Optometrist in Suwanee, GA

Q: What is Gwinnett Pediatric & Adult Eye Center's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Active since March 09, 2022

1300 PEACHTREE INDUSTRIAL BLVD STE 1206, SUWANEE, GA 30024(334) 318-0713 Get Directions Write a Review

NPPES record last updated: October 4, 2023. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Oct 4, 2023, Mar 9, 2022 (2 updates tracked since 2022).

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About Gwinnett Pediatric & Adult Eye Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GWINNETT PEDIATRIC & ADULT EYE CENTER (NPI 1578210589) is a healthcare organization registered as an optometrist in Suwanee, Georgia and active in the NPI registry since March 2022. The organization lists Shundale Thomas Mixon, Owner/od, as its authorized official.

NPPES Registry Identity

NPI1578210589

Entity TypeOrganization

Primary Taxonomy152W00000X

Legal Business NameGWINNETT PEDIATRIC & ADULT EYE CENTER

Location Address1300 PEACHTREE INDUSTRIAL BLVD STE 1206Suwanee, GA 30024-4550

Mailing Address1300 Peachtree Industrial Blvd Ste 1206Suwanee, GA 30024-4550 · (770) 783-2162

Phone(334) 318-0713

Organization SubpartNo

Authorized OfficialShundale Thomas MixonOwner/od · (770) 783-2162

Enumeration DateMarch 9, 2022

Last NPPES UpdateOctober 4, 20232 updates tracked since enumeration

NPPES CertifiedOctober 4, 2023

✔ NPI 1578210589 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers

Taxonomy Code152W00000X

Definition

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

1300 PEACHTREE INDUSTRIAL BLVD STE 1206, Suwanee, GA 30024

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Gwinnett Pediatric & Adult Eye Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Gwinnett Pediatric & Adult Eye Center, which bills Medicare for the services this clinician delivers.

Clinician (1)

Shundale Mixon, OD

Optometry

NPI 1013403088

1300 PEACHTREE INDUSTRIAL BLVD STE 1206
Suwanee, GA 30024

(334) 318-0713

✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Gwinnett Pediatric & Adult Eye Center's NPI number?

The NPI number for Gwinnett Pediatric & Adult Eye Center is 1578210589. It was assigned to this organization in the NPPES registry on March 9, 2022.

Where is Gwinnett Pediatric & Adult Eye Center located?

Gwinnett Pediatric & Adult Eye Center is located at 1300 Peachtree Industrial Blvd Ste 1206, Suwanee, GA 30024. The listed phone number is (334) 318-0713.

What is Gwinnett Pediatric & Adult Eye Center's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Gwinnett Pediatric & Adult Eye Center enrolled in Medicare?

Yes. Gwinnett Pediatric & Adult Eye Center is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Gwinnett Pediatric & Adult Eye Center?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Optometry) reassigns their Medicare billing to Gwinnett Pediatric & Adult Eye Center. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Gwinnett Pediatric & Adult Eye Center was last updated on October 4, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.