MEDICARE: OPHTHALMIC CONNECTIONS

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	156FX1101X	Ophthalmic Assistant

General Provider Information

NPI Number	:	1164180055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPHTHALMIC CONNECTIONS

Provider Business Mailing Address
First Line	:	400 W PEACHTREE ST NW UNIT 712
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-3545
Country	:	US
Telephone Number	:	770-367-7174
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 W PEACHTREE ST NW UNIT 712
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-3545
Country	:	US
Telephone Number	:	770-367-7174
Fax Number	:

Authorized Official
Title or Position	:	CERTIFIED OPHTHALMIC ASSISTANT
Name	:	MISS SHANNON HAWKINS
Credential	:
Telephone Number	:	770-367-7174

Provider Enumeration Date	:	12/07/2021
Last Update Date	:	12/07/2021

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