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General NPI Number Information
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NPI Number | 1861601452
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Entity Type | Organization
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Legal Business Name | THE OPTICAL CENTER PC
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 6945 DEER CREEK TRCE
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-5477
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Country | US
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Telephone | 404-918-1916
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Fax | 678-267-2865
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Provider Business Mailing Address
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Address Line | 6945 DEER CREEK TRCE
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-5477
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Country | US
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Telephone | 404-918-1916
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Fax | 678-267-2865
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Authorized Official
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Title or Position | OPTICIAN
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Name | MR. JEFFREY BURNETT SR.
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Credential | LDO
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Telephone | 404-918-1916
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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 |
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License Number State |
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