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General NPI Number Information
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NPI Number | 1174073134
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Entity Type | Organization
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Legal Business Name | EYEDOC INVESTMENTS LLC
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 3290 BUFORD DR SUITE B-2
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City | BUFORD
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State | GA
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Zip | 30519-4928
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Country | US
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Telephone | 724-799-1387
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Fax |
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Provider Business Mailing Address
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Address Line | 3290 BUFORD DR SUITE B-2
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City | BUFORD
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State | GA
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Zip | 30519-4928
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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/PRESIDENT
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Name | DERRICK BADARACCO
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Credential | OD
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Telephone | 724-799-1387
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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 | 002860
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License Number State | GA
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