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General NPI Number Information
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NPI Number | 1205009669
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Entity Type | Organization
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Legal Business Name | INTOWN OPTICS INC
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 01/23/2013
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Provider Practice Location Address
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Address Line | 1197 PEACHTREE ST NE STE 520
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City | ATLANTA
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State | GA
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Zip | 30361-3502
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Country | US
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Telephone | 404-874-0874
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Fax | 404-872-5216
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Provider Business Mailing Address
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Address Line | 1197 PEACHTREE ST NE STE 520
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City | ATLANTA
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State | GA
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Zip | 30361-3502
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Country | US
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Telephone | 404-874-0874
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Fax | 404-872-5216
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DARREN S LEVINE
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Credential |
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Telephone | 404-874-0874
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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 | OPT001339
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License Number State | GA
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