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General NPI Number Information
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NPI Number | 1700244472
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Entity Type | Organization
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Legal Business Name | ALPHA AND OMEGA VISION CENTER
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Dates
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Enumeration Date | 02/09/2016
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 3836 WASHINGTON RD SUITE 2
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City | MARTINEZ
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State | GA
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Zip | 30907-5058
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Country | US
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Telephone | 706-410-2038
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Fax | 706-608-4080
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Provider Business Mailing Address
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Address Line | 264 GUSTAV CT
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City | NORTH AUGUSTA
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State | SC
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Zip | 29860-8212
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Country | US
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Telephone | 803-546-5740
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHERITA SEWARD-BROWN
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Credential |
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Telephone | 803-546-5740
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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 | 002623
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License Number State | GA
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