Healthcare Provider Details

I. General information

NPI: 1982019139
Provider Name (Legal Business Name): SPECIAL CARE OPTOMETRY OF GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 PLEASANT HILL RD SUITE 5
DULUTH GA
30096-1429
US

IV. Provider business mailing address

12910 SHELBYVILLE RD SUITE 300
LOUISVILLE KY
40243-1593
US

V. Phone/Fax

Practice location:
  • Phone: 855-259-9183
  • Fax: 502-254-4082
Mailing address:
  • Phone: 502-244-2457
  • Fax: 502-254-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JESSICA VELTEN
Title or Position: DIRECTOR OF BILLING
Credential: CPC
Phone: 502-244-2457