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General NPI Number Information
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NPI Number | 1720443401
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Entity Type | Organization
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Legal Business Name | EYEDREAM EYECARE, LLC
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 7774 MCGINNIS FERRY RD
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City | SUWANEE
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State | GA
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Zip | 30024-1622
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Country | US
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Telephone | 678-540-4772
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Fax | 678-540-4752
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Provider Business Mailing Address
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Address Line | 7774 MCGINNIS FERRY RD
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City | SUWANEE
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State | GA
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Zip | 30024-1622
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Country | US
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Telephone | 678-540-4772
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Fax | 678-540-4752
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | MARIA M. KIM
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Credential | O.D
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Telephone | 678-267-5843
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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 | OPT002343
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License Number State | GA
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