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General NPI Number Information
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NPI Number | 1871971861
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Entity Type | Organization
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Legal Business Name | EYEDEAL VISION GROUP LLC
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 1922 JOHNSON FERRY RD NE UNIT E
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City | BROOKHAVEN
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State | GA
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Zip | 30319-5003
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Country | US
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Telephone | 314-703-2466
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Fax |
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Provider Business Mailing Address
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Address Line | 2650 HOLCOMB BRIDGE RD STE 510
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City | ALPHARETTA
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State | GA
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Zip | 30022-5333
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Country | US
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Telephone | 314-703-2466
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | ERIC HARRIS
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Credential | OD
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Telephone | 314-703-2466
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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 | OPT002653
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License Number State | GA
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