Healthcare Provider Details

I. General information

NPI: 1245418243
Provider Name (Legal Business Name): FOCAL POINT OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 INDIAN TRAIL RD SUITE108
NORCROSS GA
30093-2666
US

IV. Provider business mailing address

1560 INDIAN TRAIL RD SUITE108
NORCROSS GA
30093-2666
US

V. Phone/Fax

Practice location:
  • Phone: 770-923-1011
  • Fax: 770-923-1041
Mailing address:
  • Phone: 770-923-1011
  • Fax: 770-923-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberGA1647
License Number StateGA

VIII. Authorized Official

Name: DR. REGINA MCCOLLUM SULLIVAN
Title or Position: CLINICAL DIRECTOR
Credential: OPTOMETRIST
Phone: 678-478-8135