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NPI Code Detail

MEDICARE: ADVANCED EYE ASSOCIATES LLC

MEDICARE: ADVANCED EYE ASSOCIATES 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
1152WC0802XCorneal and Contact Management Optometrist152WOOOOOXGA

General Provider Information

NPI Number : 1720217771
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED EYE ASSOCIATES LLC
Provider Business Mailing Address
First Line : 2645 DALLAS HWY SW
Second Line : SUITE 100
City : MARIETTA
State : GA
Zip : 30064-2541
Country : US
Telephone Number : 770-422-8002
Fax Number : 770-422-4618
Provider Business Practice Location Address
First Line : 2645 DALLAS HWY SW
Second Line : SUITE 100
City : MARIETTA
State : GA
Zip : 30064-2541
Country : US
Telephone Number : 770-422-8002
Fax Number : 770-422-4618
Authorized Official
Title or Position : PHYSICIAN
Name : DR. ALFRED M LONG JR.
Credential : OD
Telephone Number : 770-422-8002
Provider Enumeration Date : 07/13/2009
Last Update Date : 02/22/2016

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Directions to “ADVANCED EYE ASSOCIATES LLC ” Practice Location

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