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General NPI Number Information
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NPI Number | 1720376379
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Entity Type | Organization
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Legal Business Name | GEGE ODION OD LLC
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 07/18/2011
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Provider Practice Location Address
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Address Line | 4670 RIVERSOUND DR
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City | SNELLVILLE
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State | GA
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Zip | 30039-8540
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Country | US
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Telephone | 770-265-6450
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Fax |
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Provider Business Mailing Address
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Address Line | 4670 RIVERSOUND DR
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City | SNELLVILLE
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State | GA
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Zip | 30039-8540
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GEGE ODION
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Credential | OD
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Telephone | 770-265-6450
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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 | OPT001402
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License Number State | GA
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