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General NPI Number Information
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NPI Number | 1609920289
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Entity Type | Organization
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Legal Business Name | HERITAGE VISION CENTER, INC.
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 2427 HERITAGE VLG SUITE 4
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City | SNELLVILLE
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State | GA
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Zip | 30078-2699
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Country | US
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Telephone | 770-978-2020
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Fax | 770-978-1750
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Provider Business Mailing Address
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Address Line | 2427 HERITAGE VLG SUITE 4
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City | SNELLVILLE
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State | GA
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Zip | 30078-2699
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Country | US
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Telephone | 770-978-2020
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Fax | 770-978-1750
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Authorized Official
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Title or Position | BACK OFFICE MANAGER
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Name | MRS. HEATHER KLEIN
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Credential |
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Telephone | 770-978-2020
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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 | OPT001935
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License Number State | GA
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