Healthcare Provider Details

I. General information

NPI: 1699913269
Provider Name (Legal Business Name): MOUNT VERNON EYE CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 MOUNT VERNON RD
DUNWOODY GA
30338-4224
US

IV. Provider business mailing address

1611 MOUNT VERNON RD
DUNWOODY GA
30338-4224
US

V. Phone/Fax

Practice location:
  • Phone: 770-393-0003
  • Fax: 770-393-1557
Mailing address:
  • Phone: 770-393-0003
  • Fax: 770-393-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: YURY KRICHEVSKIY
Title or Position: OFFICE MANAGER
Credential:
Phone: 770-393-0003