Healthcare Provider Details

I. General information

NPI: 1265600035
Provider Name (Legal Business Name): SURESIGHT EYECARE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 OLD MILTON PKWY STE 2
ALPHARETTA GA
30005-4467
US

IV. Provider business mailing address

3975 OLD MILTON PKWY STE 2
ALPHARETTA GA
30005-4467
US

V. Phone/Fax

Practice location:
  • Phone: 678-624-7766
  • Fax: 678-624-7775
Mailing address:
  • Phone: 678-624-7766
  • Fax: 678-624-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberGA1624
License Number StateGA

VIII. Authorized Official

Name: DR. DAVID JACKSON WAYLAND SR.
Title or Position: PRESIDENT
Credential: O.D.
Phone: 678-624-7766