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General NPI Number Information
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NPI Number | 1104010594
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Entity Type | Organization
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Legal Business Name | ROSWELL EYE CLINIC,INC
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 1190 GRIMES BRIDGE RD
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City | ROSWELL
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State | GA
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Zip | 30075-3930
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Country | US
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Telephone | 770-992-7620
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Fax | 770-992-8262
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Provider Business Mailing Address
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Address Line | 1190 GRIMES BRIDGE RD
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City | ROSWELL
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State | GA
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Zip | 30075-3930
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Country | US
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Telephone | 770-992-7620
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Fax | 770-992-8262
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. SHARON B MOSCOW
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Credential |
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Telephone | 770-992-7620
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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 | 861-T
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License Number State | GA
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