| NPI | 1386165249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA DEANN LEE Optometrist 770-712-9125 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA 1284) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: GA 1284) |
| 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: GA 1284) | |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2022-07-21 |