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General NPI Number Information
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NPI Number | 1467032771
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Entity Type | Organization
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Legal Business Name | SECOND SIGHT LLC
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Dates
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Enumeration Date | 04/11/2021
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Last Update Date | 04/11/2021
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Provider Practice Location Address
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Address Line | 112 W OAK ST
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City | GRIFFIN
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State | GA
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Zip | 30224-4233
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Country | US
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Telephone | 770-227-2924
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Fax | 770-227-2937
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Provider Business Mailing Address
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Address Line | 106 OAKDALE AVE
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3626
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Country | US
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Telephone | 770-833-3589
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROSS WILLIAM MONTGOMERY
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Credential | OD
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Telephone | 770-833-3589
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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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