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General NPI Number Information
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NPI Number | 1891234076
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Entity Type | Organization
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Legal Business Name | CARLOS E. PESSOA, OD, LLC
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 1498 MERCHANTS DR
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City | DALLAS
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State | GA
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Zip | 30132-5064
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Country | US
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Telephone | 770-445-2715
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Fax | 770-445-5805
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Provider Business Mailing Address
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Address Line | 1498 MERCHANTS DR
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City | DALLAS
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State | GA
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Zip | 30132-5064
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Country | US
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Telephone | 770-445-2715
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Fax | 770-445-5805
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. CARLOS EDUARDO PESSOA
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Credential | O.D.
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Telephone | 770-445-2715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 002495
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 002495
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 002495
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 002495
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License Number State | GA
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