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General NPI Number Information
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NPI Number | 1508100348
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Entity Type | Organization
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Legal Business Name | VISION CARE & THERAPY CENTER, INC
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Dates
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Enumeration Date | 11/17/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 12030 ETRIS RD B-100
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City | ROSWELL
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State | GA
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Zip | 30075-1410
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Country | US
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Telephone | 675-256-3990
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Fax |
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Provider Business Mailing Address
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Address Line | 8343 ROSWELL RD 141
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City | ATLANTA
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State | GA
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Zip | 30350-2810
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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 | OPTOMETRIST/PRESIDENT
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Name | JANNA IYER
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Credential | OD
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Telephone | 770-616-1991
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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 | OPT2678
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License Number State | GA
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