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General NPI Number Information
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NPI Number | 1811873888
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Entity Type | Organization
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Legal Business Name | MARIETTA EYE OPTICAL INC
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 399 MARKET PLACE BLVD STE 100
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City | CARTERSVILLE
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State | GA
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Zip | 30121-2227
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Country | US
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Telephone | 770-427-8111
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Fax | 770-499-1643
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Provider Business Mailing Address
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Address Line | PO BOX 96839
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City | CHARLOTTE
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State | NC
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Zip | 28296-6839
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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 | MANAGER
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Name | REBECCA THACKSTON
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Credential |
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Telephone | 770-427-8111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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