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General NPI Number Information
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NPI Number | 1689837593
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Entity Type | Organization
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Legal Business Name | NORTHEAST GEORGIA VISION CARE, LC
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 118 VISION DR
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City | CORNELIA
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State | GA
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Zip | 30531-5737
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Country | US
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Telephone | 706-776-6311
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Fax |
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Provider Business Mailing Address
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Address Line | 118 VISION DRIVE
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City | CORNELIA
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State | GA
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Zip | 30531
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Country | US
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Telephone | 706-776-6311
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Fax |
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Authorized Official
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Title or Position | PRES./ OWNER
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Name | DR. HOLTON S KING
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Credential | O.D.
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Telephone | 706-776-6311
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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 | 1106
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License Number State | GA
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