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General NPI Number Information
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NPI Number | 1922451913
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Entity Type | Organization
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Legal Business Name | GEORGIA FAMILY EYECARE LLC
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Dates
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Enumeration Date | 07/14/2016
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 678 LAKE JOY RD. SUITE B
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City | KATHLEEN
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State | GA
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Zip | 31047
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Country | US
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Telephone | 478-328-0900
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Fax | 478-328-2911
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Provider Business Mailing Address
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Address Line | 1112 RUSSELL PKWY SUITE C
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City | WARNER ROBINS
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State | GA
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Zip | 31088-1816
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Country | US
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Telephone | 478-328-0900
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Fax | 478-328-2911
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Authorized Official
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Title or Position | OWNER
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Name | DR. NAVID REZA KHOSHOOEE
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Credential | OD
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Telephone | 407-749-8670
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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 | OPT002845
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License Number State | GA
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