| NPI | 1629165642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD E POLAND Owner 770-995-5408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 031101) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002167) |
| 207W00000X Ophthalmology (Licence: GA 050167) | |
| 207W00000X Ophthalmology (Licence: GA 021751) | |
| 152W00000X Optometrist (Licence: GA OPT001207) | |
| 152W00000X Optometrist (Licence: GA OPT001163) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2014-12-22 |