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General NPI Number Information
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NPI Number | 1508670720
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Entity Type | Organization
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Legal Business Name | STANTON OPTICAL
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 2157 ROSWELL RD
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City | MARIETTA
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State | GA
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Zip | 30062-3814
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Country | US
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Telephone | 404-448-4745
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 744351
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City | ATLANTA
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State | GA
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Zip | 30374-4351
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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 | SENIOR REVENUE CYCLE MANAGER
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Name | ALISHA JACKSON
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Credential |
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Telephone | 561-208-1591
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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 |
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License Number State |
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