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General NPI Number Information
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NPI Number | 1023808847
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Entity Type | Organization
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Legal Business Name | INTOWN DRY EYE CARE LLC
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 125 CLAIREMONT AVE STE 485
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City | DECATUR
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State | GA
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Zip | 30030-2558
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Country | US
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Telephone | 404-968-9471
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Fax |
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Provider Business Mailing Address
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Address Line | 145 FELD AVE
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City | DECATUR
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State | GA
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Zip | 30030-3509
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Country | US
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Telephone | 404-968-9471
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ERICA LEE UDELL
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Credential | O.D.
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Telephone | 917-596-6545
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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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