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General NPI Number Information
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NPI Number | 1245418243
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Entity Type | Organization
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Legal Business Name | FOCAL POINT OPTICAL
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 1560 INDIAN TRAIL RD SUITE108
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City | NORCROSS
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State | GA
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Zip | 30093-2666
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Country | US
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Telephone | 770-923-1011
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Fax | 770-923-1041
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Provider Business Mailing Address
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Address Line | 1560 INDIAN TRAIL RD SUITE108
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City | NORCROSS
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State | GA
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Zip | 30093-2666
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Country | US
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Telephone | 770-923-1011
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Fax | 770-923-1041
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. REGINA MCCOLLUM SULLIVAN
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Credential | OPTOMETRIST
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Telephone | 678-478-8135
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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 | GA1647
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License Number State | GA
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