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General NPI Number Information
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NPI Number | 1215463260
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Entity Type | Organization
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Legal Business Name | THE EYECARE STUDIO, LLC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 09/02/2018
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Provider Practice Location Address
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Address Line | 2375 WESLEY CHAPEL RD SUITE 6
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City | DECATUR
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State | GA
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Zip | 30035
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Country | US
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Telephone | 770-987-3937
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Fax | 770-987-3917
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Provider Business Mailing Address
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Address Line | 2375 WESLEY CHAPEL RD SUITE 6
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City | DECATUR
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State | GA
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Zip | 30035-2803
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Country | US
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Telephone | 770-987-3937
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Fax | 770-987-3917
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Authorized Official
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Title or Position | PARTNER
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Name | DR. KEITH FISHE
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Credential | OD
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Telephone | 770-987-3937
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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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