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General NPI Number Information
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NPI Number | 1801063680
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Entity Type | Organization
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Legal Business Name | MICHAEL L SERRANO OD
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 06/10/2015
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Provider Practice Location Address
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Address Line | 440 ATLANTA HWY NW
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City | WINDER
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State | GA
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Zip | 30680-7826
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Country | US
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Telephone | 770-868-5992
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Fax | 770-868-1466
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Provider Business Mailing Address
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Address Line | 204 LAKE RUBY DR
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City | SUWANEE
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State | GA
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Zip | 30024-2397
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Country | US
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Telephone | 770-868-5992
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Fax | 770-868-1466
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL L SERRANO
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Credential | OD
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Telephone | 770-868-5992
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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 | GA1770
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License Number State | GA
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