Healthcare Provider Details

I. General information

NPI: 1952569279
Provider Name (Legal Business Name): NORTH GEORGIA VISION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8390 N HIGHWAY 27
ROCK SPRING GA
30739-2103
US

IV. Provider business mailing address

8390 N HIGHWAY 27
ROCK SPRING GA
30739-2103
US

V. Phone/Fax

Practice location:
  • Phone: 706-375-1720
  • Fax: 706-375-1729
Mailing address:
  • Phone: 706-375-1720
  • Fax: 706-375-1729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD0000002478
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT002352
License Number StateGA

VIII. Authorized Official

Name: MR. STEPHEN BRENT CLARK
Title or Position: OPTOMETRIST OWNER
Credential: OD
Phone: 706-375-1720