Organization
TARA FOWLER OPTOMETRIC CORPORATION
Active
Other names
Hazel Family Eyecare
Organization subpart
No
Provider details
NPI number
Authorized official
TARA LEIGH FOWLER O.D. (CEO)
(404) 414-3238
Entity
Organization
Contact information
Practice address
930 MARIETTA HWY STE 400, ROSWELL, GA 30075-6754
(770) 998-3937
(770) 783-5066
Mailing address
930 MARIETTA HWY STE 400, ROSWELL, GA 30075-6754
(770) 998-3937
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT002415
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
349274885A
—
GA
Enumeration date
06/20/2009
Last updated
01/13/2020
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