Healthcare Provider Details

I. General information

NPI: 1902190739
Provider Name (Legal Business Name): BUCKHEAD VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 PEACHTREE RD NW SUITE 301
ATLANTA GA
30305-4915
US

IV. Provider business mailing address

4746 LEGACY COVE LN
MABLETON GA
30126-2579
US

V. Phone/Fax

Practice location:
  • Phone: 404-869-5551
  • Fax: 404-869-5181
Mailing address:
  • Phone: 770-438-0202
  • Fax: 770-438-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAE CHOI
Title or Position: V.P.
Credential:
Phone: 404-869-5551