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General NPI Number Information
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NPI Number | 1073626149
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Entity Type | Organization
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Legal Business Name | TOTAL VISION, LLC
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 875 LAWRENCEVILLE SUWANEE RD #560
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-8479
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Country | US
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Telephone | 770-963-0370
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Fax | 770-682-3719
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Provider Business Mailing Address
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Address Line | 875 LAWRENCEVILLE SUWANEE RD #560
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-8479
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Country | US
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Telephone | 770-963-0370
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Fax | 770-682-3719
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAULA LYNN GORLIN
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Credential | OD
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Telephone | 770-963-0370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1882
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License Number State | GA
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