MEDICARE: VONDA RAY OD

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	OPT001783	GA

General Provider Information

NPI Number	:	1942228663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VONDA RAY OD

Provider Business Mailing Address
First Line	:	2201 HENDERSON MILL RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2711
Country	:	US
Telephone Number	:	770-934-3777
Fax Number	:	770-908-9333

Provider Business Practice Location Address
First Line	:	2201 HENDERSON MILL RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2711
Country	:	US
Telephone Number	:	770-934-3777
Fax Number	:	770-908-9333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	02/10/2015

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Directions to “ VONDA RAY OD” Practice Location

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