MEDICARE: OPTIQUE AT WEST PACES 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	1768	GA

General Provider Information

NPI Number	:	1659550515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIQUE AT WEST PACES LLC

Provider Business Mailing Address
First Line	:	1244 W PACES FERRY RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2306
Country	:	US
Telephone Number	:	404-844-1500
Fax Number	:	404-844-2700

Provider Business Practice Location Address
First Line	:	1244 W PACES FERRY RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2306
Country	:	US
Telephone Number	:	404-844-1500
Fax Number	:	404-844-2700

Authorized Official
Title or Position	:	OWNER
Name	:	GAVIN COHEN
Credential	:
Telephone Number	:	404-844-1500

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	11/07/2025

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Directions to “OPTIQUE AT WEST PACES LLC ” Practice Location

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