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NPI Code Detail

MEDICARE: REGENCY EYE CARE, INC.

MEDICARE: REGENCY EYE CARE, INC.
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
1152W00000XOptometrist

General Provider Information

NPI Number : 1063149102
Entity Type Code : Organization
Provider Name (Legal Business Name) : REGENCY EYE CARE, INC.
Provider Business Mailing Address
First Line : 2435 COMMERCE AVE BLDG 2200
Second Line :
City : DULUTH
State : GA
Zip : 30096-4980
Country : US
Telephone Number : 470-448-2782
Fax Number :
Provider Business Practice Location Address
First Line : 7155 BROADWAY
Second Line :
City : LEMON GROVE
State : CA
Zip : 91945-1408
Country : US
Telephone Number : 619-315-0192
Fax Number : 619-337-2857
Authorized Official
Title or Position : DIRECTOR
Name : LEAHANN RENE VAUGHN
Credential :
Telephone Number : 470-448-2782
Provider Enumeration Date : 08/08/2022
Last Update Date : 08/08/2022

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Directions to “REGENCY EYE CARE, INC. ” Practice Location

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