MEDICARE: UNIVERSITY VISION CENTER 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	152W00000X	Optometrist	20011100733	GA

General Provider Information

NPI Number	:	1467699629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY VISION CENTER LLC

Provider Business Mailing Address
First Line	:	1188 RALPH DAVID ABERNATHY BLVD SW
Second Line	:	SUITE 110
City	:	ATLANTA
State	:	GA
Zip	:	30310-1716
Country	:	US
Telephone Number	:	404-343-4480
Fax Number	:	404-343-4982

Provider Business Practice Location Address
First Line	:	1188 RALPH DAVID ABERNATHY BLVD SW
Second Line	:	SUITE 110
City	:	ATLANTA
State	:	GA
Zip	:	30310-1716
Country	:	US
Telephone Number	:	404-343-4480
Fax Number	:	404-343-4982

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VALERIE DIANNE ROBBINS-ACKER
Credential	:	OD
Telephone Number	:	404-343-4480

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	11/04/2013

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