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General NPI Number Information
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NPI Number | 1669521886
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Entity Type | Organization
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Legal Business Name | OPTICAL ILLUSIONS, P.C.
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 01/23/2014
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Provider Practice Location Address
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Address Line | 90 VILLAGE AT GLYNN PL
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City | BRUNSWICK
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State | GA
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Zip | 31525-1993
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Country | US
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Telephone | 912-264-6000
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Fax | 912-264-0808
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Provider Business Mailing Address
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Address Line | 90 VILLAGE AT GLYNN PL
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City | BRUNSWICK
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State | GA
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Zip | 31525-1993
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Country | US
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Telephone | 912-264-6000
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Fax | 912-264-0808
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Authorized Official
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Title or Position | CEO
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Name | DR. IAN BUCHLI
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Credential | O.D.
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Telephone | 912-264-6000
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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 | OPT0001798
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License Number State | GA
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