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General NPI Number Information
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NPI Number | 1255739637
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Entity Type | Organization
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Legal Business Name | TOTAL VISION SUWANEE LLC
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Dates
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Enumeration Date | 12/16/2014
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 1000 PEACHTREE INDUSTRIAL BLVD #14
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City | SUWANEE
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State | GA
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Zip | 30024-6737
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Country | US
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Telephone | 770-271-0611
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Fax | 770-271-5525
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Provider Business Mailing Address
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Address Line | 1000 PEACHTREE INDUSTRIAL BLVD #14
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City | SUWANEE
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State | GA
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Zip | 30024-6737
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Country | US
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Telephone | 770-271-0611
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Fax | 770-271-5525
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Authorized Official
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Title or Position | MEMBER
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Name | DR. PAULA LYNN GORLIN
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Credential | OD
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Telephone | 770-271-0611
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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 | OPT001130
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License Number State | GA
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