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General NPI Number Information
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NPI Number | 1649495938
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Entity Type | Organization
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Legal Business Name | FASHION OPTICAL, INC.
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3024 MARTIN LUTHER KING JR DR SW SUITE B
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City | ATLANTA
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State | GA
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Zip | 30311-1515
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Country | US
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Telephone | 404-691-6222
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Fax | 404-691-9988
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Provider Business Mailing Address
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Address Line | 3024 MARTIN LUTHER KING JR DR SW SUITE B
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City | ATLANTA
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State | GA
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Zip | 30311-1515
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Country | US
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Telephone | 404-691-6222
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Fax | 404-691-9988
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Authorized Official
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Title or Position | SENIOR OPTICIAN
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Name | MR. GARY GRAHAM
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Credential | L.D.O
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Telephone | 404-691-6222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | LDO001037
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License Number State | GA
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