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General NPI Number Information
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NPI Number | 1992947717
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Entity Type | Organization
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Legal Business Name | FOR YOUR EYES ONLY-EYE CARE INC
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 12/17/2010
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Provider Practice Location Address
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Address Line | 5851 S VICKERY
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City | CUMMING
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State | GA
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Zip | 30040-8793
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Country | US
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Telephone | 678-682-9299
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Fax |
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Provider Business Mailing Address
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Address Line | 5851 S VICKERY ST.
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City | CUMMING
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State | GA
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Zip | 30040-8793
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Country | US
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Telephone | 678-682-9299
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MIRA KALMAN SIVAN
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Credential | OD
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Telephone | 678-682-9299
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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 | 2413
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License Number State | GA
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