Healthcare Provider Details

I. General information

NPI: 1568657880
Provider Name (Legal Business Name): FIVE POINTS OPTOMETRISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 S MILLEDGE AVE
ATHENS GA
30605-1251
US

IV. Provider business mailing address

698 S MILLEDGE AVE
ATHENS GA
30605-1251
US

V. Phone/Fax

Practice location:
  • Phone: 706-543-2020
  • Fax: 706-549-6618
Mailing address:
  • Phone: 706-543-2020
  • Fax: 706-549-6618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. ROSE MARIE ISREAL
Title or Position: BILLING MANAGER
Credential:
Phone: 706-543-2020