Healthcare Provider Details

I. General information

NPI: 1588073050
Provider Name (Legal Business Name): ENFOCUS EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 ERNEST W BARRETT PKWY SW
MARIETTA GA
30064-4571
US

IV. Provider business mailing address

6520 ERNEST W BARRETT PKWY SW
MARIETTA GA
30064-4571
US

V. Phone/Fax

Practice location:
  • Phone: 770-222-6603
  • Fax:
Mailing address:
  • Phone: 770-222-6603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberOPT002835
License Number StateGA

VIII. Authorized Official

Name: DR. AARON MICHAEL RAHN
Title or Position: OWNER
Credential: O.D.
Phone: 404-421-3957