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General NPI Number Information
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NPI Number | 1982677357
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Entity Type | Organization
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Legal Business Name | GEORGIA VISION CENTER
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 1620 HIGHWAY 76 WEST SUITE 3
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City | HIAWASSEE
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State | GA
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Zip | 30546
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Country | US
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Telephone | 706-896-3303
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Fax | 706-896-9485
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Provider Business Mailing Address
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Address Line | 1620 HIGHWAY 76 WEST SUITE 3
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City | HIAWASSEE
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State | GA
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Zip | 30546
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Country | US
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Telephone | 706-896-3303
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Fax | 706-896-9485
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Authorized Official
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Title or Position | DOCTOR OWNER
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Name | JOSE MAITAS ARENCIBIA
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Credential | OD
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Telephone | 706-896-3303
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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 | OPT001176
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License Number State | GA
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