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General NPI Number Information
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NPI Number | 1134945447
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Entity Type | Organization
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Legal Business Name | VISIONARY DRY EYE INSTITUTE
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 2550 WINDY HILL RD SE STE 320
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City | MARIETTA
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State | GA
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Zip | 30067-8655
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Country | US
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Telephone | 770-428-0414
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Fax | 770-428-0415
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Provider Business Mailing Address
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Address Line | 2550 WINDY HILL RD SE STE 320
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City | MARIETTA
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State | GA
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Zip | 30067-8655
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Country | US
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Telephone | 770-428-0414
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Fax | 770-428-0415
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JANELLE L DAVISON
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Credential | OD
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Telephone | 770-428-0414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number |
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License Number State |
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