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General NPI Number Information
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NPI Number | 1184208290
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Entity Type | Organization
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Legal Business Name | OLIVE EYECARE INC
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Dates
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Enumeration Date | 05/06/2021
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 2427 GRESHAM RD SE
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City | ATLANTA
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State | GA
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Zip | 30316-3709
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Country | US
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Telephone | 770-743-6971
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Fax |
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Provider Business Mailing Address
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Address Line | 4480H S COBB DR SE STE 124
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City | SMYRNA
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State | GA
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Zip | 30080-6958
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Country | US
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Telephone | 770-743-6971
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. TIFFANY D BROWN
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Credential |
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Telephone | 225-747-7597
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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 |
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License Number State |
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