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General NPI Number Information
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NPI Number | 1871922385
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Entity Type | Organization
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Legal Business Name | DORFZAUN EYE GROUP,L.L.C.
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 08/11/2015
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Provider Practice Location Address
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Address Line | 850 OLD PIEDMONT RD
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City | MARIETTA
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State | GA
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Zip | 30066-5490
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Country | US
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Telephone | 770-422-3677
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Fax | 770-422-5814
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Provider Business Mailing Address
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Address Line | 850 OLD PIEDMONT RD
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City | MARIETTA
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State | GA
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Zip | 30066-5490
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Country | US
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Telephone | 770-422-3677
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Fax | 770-422-5814
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | SANDER S DORFZAUN
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Credential | O.D.
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Telephone | 770-422-3677
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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 | GA754
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License Number State | GA
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