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NPI Code Detail

MEDICARE: SUWANEE EYE CENTER

MEDICARE: SUWANEE EYE CENTER
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
1152W00000XOptometristOPT2033GA

General Provider Information

NPI Number : 1194999003
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUWANEE EYE CENTER
Provider Business Mailing Address
First Line : 2383 WATERFORD CV
Second Line :
City : DECATUR
State : GA
Zip : 30033-1332
Country : US
Telephone Number : 404-471-9990
Fax Number :
Provider Business Practice Location Address
First Line : 2957 N DRUID HILLS RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30329-3909
Country : US
Telephone Number : 404-471-9990
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. GRIGORIY SOLOMON
Credential : O.D
Telephone Number : 404-471-9990
Provider Enumeration Date : 04/22/2008
Last Update Date : 04/22/2008

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