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General NPI Number Information
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NPI Number | 1225793250
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Entity Type | Organization
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Legal Business Name | DIGITAL VISION OPTICAL LLC
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 5582 MEMORIAL DR STE 201
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-3215
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Country | US
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Telephone | 678-335-6130
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Fax | 678-335-6336
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Provider Business Mailing Address
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Address Line | 5582 MEMORIAL DR STE 201
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-3215
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Country | US
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Telephone | 678-335-6130
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Fax | 678-335-6336
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Authorized Official
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Title or Position | MD., OWNER, AUTHORIZED OFFICIAL
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Name | KEITH THOMPSON
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Credential | MD
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Telephone | 678-335-6130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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