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General NPI Number Information
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NPI Number | 1124232228
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Entity Type | Organization
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Legal Business Name | 2020 EYE CARE
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10945 STATE BRIDGE RD SUITE 306
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City | ALPHARETTA
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State | GA
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Zip | 30022-8164
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Country | US
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Telephone | 678-339-0423
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Fax |
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Provider Business Mailing Address
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Address Line | 10945 STATE BRIDGE RD SUITE 306
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City | ALPHARETTA
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State | GA
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Zip | 30022-8164
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Country | US
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Telephone | 678-339-0423
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMIA IDRIS
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Credential | O.D
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Telephone | 678-339-0423
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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 | OPT001870
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License Number State | GA
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