MEDICARE: ATL OPTICAL 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
1	152W00000X	Optometrist
2	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1154085306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATL OPTICAL LLC

Provider Business Mailing Address
First Line	:	1943 PLEASANT HILL RD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1671 HOWELL MILL RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-3118
Country	:	US
Telephone Number	:	956-335-6476
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SUPERVISOR
Name	:	JACKIE BENNETT
Credential	:
Telephone Number	:	561-433-6009

Provider Enumeration Date	:	10/25/2021
Last Update Date	:	10/25/2021

Similar Medicare Providers

1548537095 — ALYSSA J MELLOR LCSW
Practice Location Address:

914 COLLIER RD NW APT 3118
ATLANTA, GA
30318-2575

Practice Phone: 207-319-2070
Practice Fax:

1255564670 — MRS. SAROSA MARTIN-CLARK LCSW
Practice Location Address:

3118 GARDEN WALK SW
ATLANTA, GA
30331-5462

Practice Phone: 404-629-0923
Practice Fax:

1841578853 — SOUTH ATLANTA MEDICAL GROUP, INC
Practice Location Address:

2643 CALDWELL RD NE
ATLANTA, GA
30319-3118

Practice Phone: 678-328-0577
Practice Fax:

1912270471 — LIFE LINE HOME CARE INC
Practice Location Address:

2250 N DRUID HILLS RD NE STE 133
ATLANTA, GA
30329-3118

Practice Phone: 404-876-1503
Practice Fax: 404-876-1505

1588910145 — MISS KALA EVANS LMT
Practice Location Address:

1075 PEACHTREE ST NE UNIT 3118
ATLANTA, GA
30309-3912

Practice Phone: 770-765-1076
Practice Fax:

1295086924 — WILLIAM KELLY BROWN LPC
Practice Location Address:

2250 N DRUID HILLS RD NE STE 135
ATLANTA, GA
30329-3118

Practice Phone: 770-828-5441
Practice Fax:

Directions to “ATL OPTICAL LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.