Healthcare Provider Details

I. General information

NPI: 1154999183
Provider Name (Legal Business Name): MALERBI VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 W WALNUT AVE
DALTON GA
30720-3958
US

IV. Provider business mailing address

2141 VINEWOOD DR
DALTON GA
30720-5938
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-2722
  • Fax:
Mailing address:
  • Phone: 706-537-8574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRIANNA MALERBI
Title or Position: CFO/OWNER
Credential:
Phone: 706-537-8574