Healthcare Provider Details

I. General information

NPI: 1104470400
Provider Name (Legal Business Name): MORNINGSTAR M&W, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11030 MEDLOCK BRIDGE RD STE 140
JOHNS CREEK GA
30097-3503
US

IV. Provider business mailing address

11030 MEDLOCK BRIDGE RD STE 140
JOHNS CREEK GA
30097-3503
US

V. Phone/Fax

Practice location:
  • Phone: 404-939-6008
  • Fax:
Mailing address:
  • Phone: 617-935-5754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RONNIE MAK
Title or Position: OWNER
Credential:
Phone: 404-939-6008