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General NPI Number Information
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NPI Number | 1609102458
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Entity Type | Organization
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Legal Business Name | CHITA EYE ASSOCIATES P.C.
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 270 WALMART WAY
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City | DAHLONEGA
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State | GA
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Zip | 30533-0824
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Country | US
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Telephone | 678-481-8132
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Fax |
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Provider Business Mailing Address
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Address Line | 6795 BRAGG RD
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City | CUMMING
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State | GA
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Zip | 30041-4701
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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 | PRESIDENT
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Name | DR. LINH TA
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Credential | O.D.
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Telephone | 678-481-8132
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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 | OPT001539
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License Number State | GA
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