Healthcare Provider Details

I. General information

NPI: 1023517471
Provider Name (Legal Business Name): INFOCUS EYE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 ARBOR PLACE MALL
DOUGLASVILLE GA
30135-7105
US

IV. Provider business mailing address

165 OLIVIA RUN
ATLANTA GA
30349-7614
US

V. Phone/Fax

Practice location:
  • Phone: 770-942-9827
  • Fax:
Mailing address:
  • Phone: 770-942-9827
  • Fax:

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 TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALISA KOURTNEY NICHOLSON
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 662-251-1421