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General NPI Number Information
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NPI Number | 1972836013
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Entity Type | Organization
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Legal Business Name | DISTINCTIVE EYE CARE PC
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Dates
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Enumeration Date | 09/08/2009
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 6750 JAMESTOWN DRIVE
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City | ALPHARETTA
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State | GA
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Zip | 30005-3030
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Country | US
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Telephone | 678-691-0073
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Fax | 888-707-4495
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Provider Business Mailing Address
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Address Line | 6750 JAMESTOWN DRIVE
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City | ALPHARETTA
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State | GA
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Zip | 30005-3030
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Country | US
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Telephone | 678-691-0073
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Fax | 888-707-4495
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. JENNIFER MARSHALL JAIKARAN
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Credential | O.D.
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Telephone | 678-691-0073
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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 | OPT002111
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License Number State | GA
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