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General NPI Number Information
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NPI Number | 1124189113
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Entity Type | Organization
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Legal Business Name | S P D OPTICAL INC
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 3700 ATLANTA HWY
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City | ATHENS
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State | GA
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Zip | 30606-7201
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Country | US
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Telephone | 706-543-7925
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Fax | 706-546-9025
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Provider Business Mailing Address
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Address Line | 3700 ATLANTA HWY
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City | ATHENS
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State | GA
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Zip | 30606-7201
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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 | OWNER
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Name | MR. PHILIP FRIEDLAND
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Credential | LDO
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Telephone | 706-543-7925
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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 | 001503
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License Number State | GA
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