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General NPI Number Information
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NPI Number | 1699905075
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Entity Type | Organization
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Legal Business Name | G3B OPTICAL HOLDINGS, LLC
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 10/20/2009
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Provider Practice Location Address
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Address Line | 3005 OLD ALABAMA RD SUITE 300
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City | ALPHARETTA
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State | GA
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Zip | 30022-8594
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Country | US
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Telephone | 678-393-9445
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Fax | 678-298-8503
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Provider Business Mailing Address
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Address Line | 3005 OLD ALABAMA RD SUITE 300
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City | ALPHARETTA
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State | GA
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Zip | 30022-8594
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Country | US
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Telephone | 678-393-9445
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Fax | 678-298-8503
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | CHRISTY F JAILLET
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Credential | O.D.
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Telephone | 678-393-9445
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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 | OPT-001864
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License Number State | GA
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