Healthcare Provider Details

I. General information

NPI: 1235549536
Provider Name (Legal Business Name): A PLUS OPTIQUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 HIGHWAY 54 W STE 307
FAYETTEVILLE GA
30214-4563
US

IV. Provider business mailing address

PO BOX 144085
FAYETTEVILLE GA
30214-6543
US

V. Phone/Fax

Practice location:
  • Phone: 678-834-7411
  • Fax: 678-834-7432
Mailing address:
  • Phone: 678-834-7411
  • Fax: 678-834-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberLDO002220
License Number StateGA

VIII. Authorized Official

Name: CRYSTAL WADE
Title or Position: OPTOMETRIST
Credential: OD
Phone: 678-834-7411