Organization
PARKSIDE OPTIQUE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA STONEBRAKER LDO (OWNER/DISPENSING OPTICIAN)
(770) 485-7459
Entity
Organization
Contact information
Practice address
105 E MAIN ST STE 116, WOODSTOCK, GA 30188-5013
(770) 485-7459
Mailing address
105 E MAIN ST STE 116, WOODSTOCK, GA 30188-5013
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
156FX1800X
Optician
Primary
—
—
Other
Enumeration date
07/25/2017
Last updated
07/25/2017
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