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NPI Code Detail

MEDICARE: GA DOCTORS OF OPTOMETRY LLC

MEDICARE: GA DOCTORS OF OPTOMETRY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332H00000XEyewear Supplier

General Provider Information

NPI Number : 1013599745
Entity Type Code : Organization
Provider Name (Legal Business Name) : GA DOCTORS OF OPTOMETRY LLC
Provider Business Mailing Address
First Line : 175 E HOUSTON ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78205-2255
Country : US
Telephone Number : 726-444-4078
Fax Number :
Provider Business Practice Location Address
First Line : 6783 VETERANS PKWY STE 100
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-3284
Country : US
Telephone Number : 706-323-0260
Fax Number : 706-323-0261
Authorized Official
Title or Position : OWNER
Name : MATTHEW MARSICH
Credential : OD
Telephone Number : 726-444-4078
Provider Enumeration Date : 04/22/2021
Last Update Date : 04/22/2021

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Directions to “GA DOCTORS OF OPTOMETRY LLC ” Practice Location

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