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General NPI Number Information
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NPI Number | 1114382546
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Entity Type | Organization
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Legal Business Name | EYELOGIC, LLC
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Dates
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Enumeration Date | 12/30/2015
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 1295 OLD PEACHTREE RD NW STE 160
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City | SUWANEE
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State | GA
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Zip | 30024-2737
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Country | US
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Telephone | 770-545-8401
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Fax |
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Provider Business Mailing Address
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Address Line | 1295 OLD PEACHTREE RD NW STE 160
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City | SUWANEE
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State | GA
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Zip | 30024-2737
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST AND OWNER
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Name | SARA S YUM
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Credential | O.D.
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Telephone | 770-545-8401
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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 | 002563
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License Number State | GA
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