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NPI Code Detail

MEDICARE: SELECT EYECARE LLC

MEDICARE: SELECT EYECARE 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
1152W00000XOptometrist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912610874
Entity Type Code : Organization
Provider Name (Legal Business Name) : SELECT EYECARE LLC
Provider Business Mailing Address
First Line : 6945 DEER CREEK TRCE
Second Line :
City : STONE MOUNTAIN
State : GA
Zip : 30087-5477
Country : US
Telephone Number : 404-918-1915
Fax Number : 478-910-1030
Provider Business Practice Location Address
First Line : 4221 ATLANTA HWY
Second Line :
City : LOGANVILLE
State : GA
Zip : 30052-7316
Country : US
Telephone Number : 478-368-5385
Fax Number : 478-910-1030
Authorized Official
Title or Position : CEO
Name : DR. ALISA JOYCE BURNETT
Credential : OD
Telephone Number : 404-918-1915
Provider Enumeration Date : 01/05/2023
Last Update Date : 08/27/2025

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