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General NPI Number Information
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NPI Number | 1184342818
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Entity Type | Organization
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Legal Business Name | TASOBB, LLC
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 10779 ALPHARETTA HWY
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City | ROSWELL
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State | GA
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Zip | 30076-5677
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Country | US
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Telephone | 404-910-2690
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Fax |
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Provider Business Mailing Address
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Address Line | 135 N RIVER DR UNIT E
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City | ATLANTA
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State | GA
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Zip | 30350-1906
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Country | US
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Telephone | 404-910-2690
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARIANA QUEIROZ
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Credential |
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Telephone | 404-910-2690
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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 |
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License Number State |
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