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General NPI Number Information
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NPI Number | 1952569279
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Entity Type | Organization
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Legal Business Name | NORTH GEORGIA VISION CENTER INC
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 8390 N HIGHWAY 27
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City | ROCK SPRING
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State | GA
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Zip | 30739-2103
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Country | US
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Telephone | 706-375-1720
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Fax | 706-375-1729
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Provider Business Mailing Address
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Address Line | 8390 N HIGHWAY 27
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City | ROCK SPRING
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State | GA
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Zip | 30739-2103
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Country | US
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Telephone | 706-375-1720
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Fax | 706-375-1729
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Authorized Official
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Title or Position | OPTOMETRIST OWNER
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Name | MR. STEPHEN BRENT CLARK
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Credential | OD
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Telephone | 706-375-1720
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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 | OD0000002478
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002352
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License Number State | GA
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