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General NPI Number Information
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NPI Number | 1578902086
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Entity Type | Organization
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Legal Business Name | NORCROSS EYE CENTER
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Dates
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Enumeration Date | 06/18/2013
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Last Update Date | 06/18/2013
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Provider Practice Location Address
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Address Line | 1560 INDIAN TRAIL LILBURN RD SUITE 108
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City | NORCROSS
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State | GA
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Zip | 30093-2666
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Country | US
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Telephone | 404-735-9513
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Fax |
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Provider Business Mailing Address
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Address Line | 1560 INDIAN TRAIL LILBURN RD SUITE 108
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City | NORCROSS
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State | GA
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Zip | 30093-2666
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Country | US
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Telephone | 404-735-9513
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GODWIN I EKEKHOMEN
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Credential | OD
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Telephone | 404-735-9513
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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 | OPT002372
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License Number State | GA
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