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General NPI Number Information
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NPI Number | 1467524090
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Entity Type | Organization
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Legal Business Name | EASTMETRO EYECARE P.C.
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1013 E FREEWAY DR SE
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City | CONYERS
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State | GA
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Zip | 30094-5965
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Country | US
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Telephone | 770-922-7906
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Fax | 770-483-0498
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Provider Business Mailing Address
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Address Line | 1013 E FREEWAY DR SE
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City | CONYERS
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State | GA
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Zip | 30094-5965
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Country | US
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Telephone | 770-922-7906
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Fax | 770-483-0498
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Authorized Official
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Title or Position | INSURANCE
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Name | MRS. TIMMIE BAILEY
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Credential |
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Telephone | 770-922-7906
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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 | 796
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License Number State | GA
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