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General NPI Number Information
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NPI Number | 1992431118
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Entity Type | Organization
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Legal Business Name | BOLT EYE GROUP - JOHNSON CITY, LLC
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 1207 N ROAN ST, SUITE 200
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City | JOHNSON CITY
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State | TN
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Zip | 37601
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Country | US
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Telephone | 423-928-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 4180 OLD MILTON PARKWAY
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City | ALPHARETTA
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State | GA
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Zip | 30005
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | BARBARA WILLIAMS
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Credential |
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Telephone | 770-776-9000
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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 |
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License Number State |
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