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General NPI Number Information
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NPI Number | 1598131138
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Entity Type | Organization
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Legal Business Name | EYE ELEMENTS GROUP,LLC
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Dates
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Enumeration Date | 08/18/2015
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 867 PEACHTREE STREET NE SUITE 102
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City | ATLANTA
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State | GA
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Zip | 30308
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Country | US
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Telephone | 770-399-0488
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Fax | 770-396-4291
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Provider Business Mailing Address
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Address Line | 4505 ASHFORD DUNWOODY ROAD NE SUITE 1
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City | ATLANTA
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State | GA
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Zip | 30346-1516
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Country | US
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Telephone | 770-399-0488
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Fax | 770-396-4291
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MICHAEL WAYNE HUNG
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Credential | OD
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Telephone | 770-399-0488
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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 | 001925
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License Number State | GA
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