Provider Demographics
NPI:1366498214
Name:PURVIS, JAMES L (O D)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:PURVIS
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 OZORA RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-6650
Mailing Address - Country:US
Mailing Address - Phone:678-643-6116
Mailing Address - Fax:
Practice Address - Street 1:844 OZORA RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-6650
Practice Address - Country:US
Practice Address - Phone:678-643-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000866152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1366498214OtherNPI
GA000161257LMedicaid
GAU22382Medicare UPIN