Healthcare Provider Details

I. General information

NPI: 1851226369
Provider Name (Legal Business Name): EYE TRAUMA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S COLUMBIA RD
GRAND FORKS ND
58201-4036
US

IV. Provider business mailing address

3343 PEACHTREE RD NE STE 145
ATLANTA GA
30326-1427
US

V. Phone/Fax

Practice location:
  • Phone: 470-514-0551
  • Fax:
Mailing address:
  • Phone: 470-514-0551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOE BRADLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 470-514-0551