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General NPI Number Information
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NPI Number | 1346880903
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Entity Type | Organization
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Legal Business Name | WOODSTOCK EYESITE INC
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 2360 TOWNE LAKE PKWY STE 104
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City | WOODSTOCK
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State | GA
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Zip | 30189-5576
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Country | US
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Telephone | 770-479-0123
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Fax | 770-720-0104
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Provider Business Mailing Address
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Address Line | 1455 RIVERSTONE PKWY STE 110
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City | CANTON
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State | GA
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Zip | 30114-5627
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Country | US
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Telephone | 770-479-0123
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Fax | 770-720-0104
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Authorized Official
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Title or Position | INSURANCE SPECIALIST
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Name | MS. JESSICA E NADEAU
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Credential |
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Telephone | 770-479-0123
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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 |
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License Number State |
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