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General NPI Number Information
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NPI Number | 1538412143
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Entity Type | Organization
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Legal Business Name | EYE CARE OF GEORGIA
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | EYE CARE OF GEORGIA 316 WEST PIKE STREET STE 200
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046
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Country | US
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Telephone | 770-682-3937
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Fax | 770-682-3932
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Provider Business Mailing Address
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Address Line | EYE CARE OF GEORGIA 316 WEST PIKE STREET STE 200
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046
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Country | US
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Telephone | 770-682-3937
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Fax | 770-682-3932
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MALLORY PARIKH
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Credential |
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Telephone | 678-943-7217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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