Healthcare Provider Details

I. General information

NPI: 1477486728
Provider Name (Legal Business Name): MACWAN EYE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 LOWER ROSWELL RD STE 20-40
MARIETTA GA
30068-4375
US

IV. Provider business mailing address

4880 LOWER ROSWELL RD STE 20-40
MARIETTA GA
30068-4375
US

V. Phone/Fax

Practice location:
  • Phone: 609-649-4202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RIMA MACWAN
Title or Position: OWNER
Credential: OD
Phone: 609-649-4202