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General NPI Number Information
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NPI Number | 1235549536
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Entity Type | Organization
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Legal Business Name | A PLUS OPTIQUE
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 04/10/2020
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Provider Practice Location Address
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Address Line | 1240 HIGHWAY 54 W STE 306
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4563
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Country | US
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Telephone | 678-834-7411
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Fax | 678-834-7432
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Provider Business Mailing Address
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Address Line | 7492 PARKLAND BND
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City | FAIRBURN
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State | GA
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Zip | 30213-5422
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Country | US
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Telephone | 678-834-7411
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Fax | 678-834-7432
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Authorized Official
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Title or Position | OWNER
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Name | CRYSTAL WADE
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Credential | LDO
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Telephone | 678-834-7411
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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 | LDO002220
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License Number State | GA
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