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General NPI Number Information
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NPI Number | 1790197366
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Entity Type | Organization
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Legal Business Name | SUSAN REIMBOLD O.D., P.C.
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Dates
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Enumeration Date | 05/29/2014
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Last Update Date | 05/29/2014
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Provider Practice Location Address
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Address Line | 4180 OLD MILTON PKWY SUITE 1-D
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City | ALPHARETTA
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State | GA
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Zip | 30005-2408
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Country | US
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Telephone | 770-776-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 4180 OLD MILTON PKWY SUITE 1-D
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City | ALPHARETTA
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State | GA
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Zip | 30005-2408
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Country | US
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Telephone | 770-776-9000
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Fax |
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Authorized Official
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Title or Position | OPTOMETRY
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Name | DR. SUSAN REIMBOLD
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Credential | OD
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Telephone | 770-776-9000
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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 | GA001567
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License Number State | GA
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