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General NPI Number Information
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NPI Number | 1316002926
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Entity Type | Individual
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Provider Name | GARY THOMAS PENCE O.D.
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Gender | Male
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4651 CHAMBLEE DUNWOODY RD SUITE A
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City | ATLANTA
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State | GA
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Zip | 30338-6339
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Country | US
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Telephone | 770-394-2110
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Fax |
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Provider Business Mailing Address
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Address Line | 4045 SPINNAKER DR
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City | DULUTH
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State | GA
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Zip | 30096-5264
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Country | US
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Telephone | 770-623-9370
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1290-T
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License Number State | GA
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