Healthcare Provider Details

I. General information

NPI: 1932397551
Provider Name (Legal Business Name): GWINNETT OPTICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5635 PEACHTREE PARKWAY SUITE 175
NORCROSS GA
30092-6400
US

IV. Provider business mailing address

5635 PEACHTREE PARKWAY SUITE 175
NORCROSS GA
30092-6400
US

V. Phone/Fax

Practice location:
  • Phone: 770-448-6875
  • Fax: 770-449-3091
Mailing address:
  • Phone: 770-448-6875
  • Fax: 770-449-3091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY DENNIS MASUEEI
Title or Position: CEO
Credential:
Phone: 770-448-6875