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General NPI Number Information
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NPI Number | 1023517471
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Entity Type | Organization
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Legal Business Name | INFOCUS EYE CARE, INC.
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 1270 ARBOR PLACE MALL
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-7105
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Country | US
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Telephone | 770-942-9827
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Fax |
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Provider Business Mailing Address
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Address Line | 165 OLIVIA RUN
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City | ATLANTA
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State | GA
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Zip | 30349-7614
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Country | US
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Telephone | 770-942-9827
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. ALISA KOURTNEY NICHOLSON
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Credential | OD
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Telephone | 662-251-1421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number |
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License Number State |
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Taxonomy #3
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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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