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General NPI Number Information
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NPI Number | 1881224681
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Entity Type | Organization
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Legal Business Name | SIDE EYE LLC
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Dates
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Enumeration Date | 01/21/2020
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Last Update Date | 01/21/2020
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Provider Practice Location Address
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Address Line | 47 JEFFERSON ST
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City | NEWNAN
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State | GA
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Zip | 30263-1948
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Country | US
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Telephone | 770-254-0200
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Fax | 770-254-1281
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Provider Business Mailing Address
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Address Line | 106 OAKDALE AVE
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3626
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Country | US
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Telephone | 770-833-3589
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Fax |
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Authorized Official
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Title or Position | MEMBER OWNER
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Name | DR. NANCY S BARR
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Credential | O.D.
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Telephone | 404-310-1593
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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 |
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License Number State |
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