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General NPI Number Information
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NPI Number | 1396044483
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Entity Type | Organization
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Legal Business Name | STEPHENS EYE ASSOCIATES 401 K PLAN
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 285 BOULEVARD SUITE 540
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City | ATLANTA
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State | GA
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Zip | 30312-4214
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Country | US
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Telephone | 404-582-0096
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Fax |
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Provider Business Mailing Address
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Address Line | 285 BOULEVARD SUITE 540
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City | ATLANTA
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State | GA
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Zip | 30312-4214
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | HARRITTIA WILFORD
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Credential |
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Telephone | 404-582-0096
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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 | GA041970
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | GA041970
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License Number State | GA
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