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General NPI Number Information
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NPI Number | 1104257740
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Entity Type | Organization
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Legal Business Name | CARTERSVULLE VISION
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 239 MARKET PLACE BLVD
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City | CARTERSVILLE
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State | GA
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Zip | 30121-2235
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Country | US
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Telephone | 770-607-1448
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Fax | 770-607-1408
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Provider Business Mailing Address
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Address Line | 239 MARKET PLACE BLVD
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City | CARTERSVILLE
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State | GA
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Zip | 30121-2235
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Country | US
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Telephone | 770-607-1448
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Fax | 770-607-1408
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Authorized Official
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Title or Position | OWNER
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Name | MR. KEITH BACHMANN
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Credential | C.E.O.
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Telephone | 770-479-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | LDO001270
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License Number State | GA
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