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General NPI Number Information
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NPI Number | 1437279569
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Entity Type | Organization
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Legal Business Name | EKHOS OPTICAL INC
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2948 FIVE FORKS TRICKUM RD SUITE C
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-5872
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Country | US
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Telephone | 770-736-7774
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Fax |
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Provider Business Mailing Address
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Address Line | 2948 FIVE FORKS TRICKUM RD SUITE C
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-5872
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Country | US
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Telephone | 770-736-7774
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JOSEPH IMAFIDON
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Credential | OPT
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Telephone | 770-736-7774
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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 | GA0832
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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