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General NPI Number Information
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NPI Number | 1003445412
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Entity Type | Organization
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Legal Business Name | SUPERIOR EYECARE OF GRIFFIN
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Dates
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Enumeration Date | 04/07/2020
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Last Update Date | 04/07/2020
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Provider Practice Location Address
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Address Line | 1569 N EXPRESSWAY
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City | GRIFFIN
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State | GA
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Zip | 30223-1746
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Country | US
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Telephone | 770-233-6860
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Fax |
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Provider Business Mailing Address
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Address Line | 1569 N EXPRESSWAY
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City | GRIFFIN
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State | GA
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Zip | 30223-1746
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Country | US
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Telephone | 770-233-6860
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Fax |
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Authorized Official
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Title or Position | OWNER/ OPTOMETRIST
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Name | DR. MALIQUE PAYNE
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Credential | O.D.
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Telephone | 917-250-4468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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