MEDICARE: VISIONARY DRY EYE INSTITUTE

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
1	152WC0802X	Corneal and Contact Management Optometrist

General Provider Information

NPI Number	:	1134945447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONARY DRY EYE INSTITUTE

Provider Business Mailing Address
First Line	:	2550 WINDY HILL RD SE STE 320
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8655
Country	:	US
Telephone Number	:	770-428-0414
Fax Number	:	770-428-0415

Provider Business Practice Location Address
First Line	:	2550 WINDY HILL RD SE STE 320
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8655
Country	:	US
Telephone Number	:	770-428-0414
Fax Number	:	770-428-0415

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JANELLE L DAVISON
Credential	:	OD
Telephone Number	:	770-428-0414

Provider Enumeration Date	:	12/02/2024
Last Update Date	:	12/30/2024

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