=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588960884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH GEORGIA OPTICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2011
-----------------------------------------------------
Last Update Date | 02/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10775 ALPHARETTA HWY
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-998-0331
-----------------------------------------------------
Fax | 770-998-4634
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10775 ALPHARETTA HWY
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-998-0331
-----------------------------------------------------
Fax | 770-998-4634
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | DR. HOWARD HARRY OIFER
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 770-998-0331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 0913
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------