Healthcare Provider Details

I. General information

NPI: 1811873888
Provider Name (Legal Business Name): MARIETTA EYE OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 MARKET PLACE BLVD STE 100
CARTERSVILLE GA
30121-2227
US

IV. Provider business mailing address

PO BOX 96839
CHARLOTTE NC
28296-6839
US

V. Phone/Fax

Practice location:
  • Phone: 770-427-8111
  • Fax: 770-499-1643
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA THACKSTON
Title or Position: MANAGER
Credential:
Phone: 770-427-8111