Healthcare Provider Details

I. General information

NPI: 1790197366
Provider Name (Legal Business Name): SUSAN REIMBOLD O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180 OLD MILTON PKWY SUITE 1-D
ALPHARETTA GA
30005-2408
US

IV. Provider business mailing address

4180 OLD MILTON PKWY SUITE 1-D
ALPHARETTA GA
30005-2408
US

V. Phone/Fax

Practice location:
  • Phone: 770-776-9000
  • Fax:
Mailing address:
  • Phone: 770-776-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberGA001567
License Number StateGA

VIII. Authorized Official

Name: DR. SUSAN REIMBOLD
Title or Position: OPTOMETRY
Credential: OD
Phone: 770-776-9000