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General NPI Number Information
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NPI Number | 1205127925
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Entity Type | Organization
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Legal Business Name | EYEWATCH EYE CARE AND ASSOCIATES LLC
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 04/29/2011
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Provider Practice Location Address
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Address Line | 1550 MALL OF GEORGIA BLVD
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City | BUFORD
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State | GA
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Zip | 30519-6551
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Country | US
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Telephone | 678-288-3024
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Fax | 678-482-1324
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Provider Business Mailing Address
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Address Line | 3592 HUDDLESTONE LN
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City | BUFORD
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State | GA
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Zip | 30519-4652
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Country | US
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Telephone | 678-288-3024
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Fax | 678-889-9546
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Authorized Official
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Title or Position | OWNER
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Name | DR. ADEKUNLE EMMANUEL OLUWADARE
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Credential | O.D, M.S
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Telephone | 610-800-1125
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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 | OPT2345
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License Number State | GA
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