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General NPI Number Information
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NPI Number | 1750342093
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Entity Type | Organization
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Legal Business Name | NEW VISION EYE CARE CENTER INC
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1501 SHORTER AVE SW
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City | ROME
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State | GA
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Zip | 30165-3964
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Country | US
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Telephone | 706-232-6464
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Fax | 706-232-3674
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Provider Business Mailing Address
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Address Line | 1501 SHORTER AVE SW
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City | ROME
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State | GA
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Zip | 30165-3964
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Country | US
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Telephone | 706-232-6464
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Fax | 706-232-3674
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Authorized Official
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Title or Position | MANAGER/OPTICIAN
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Name | MR. HAYES JOLLY WANSLEY
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Credential | LDO
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Telephone | 706-232-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1587
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License Number State |
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