Organization
A PLUS OPTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL WADE LDO (OWNER)
(678) 834-7411
Entity
Organization
Contact information
Practice address
1240 HIGHWAY 54 W STE 306, FAYETTEVILLE, GA 30214-4563
(678) 834-7411
(678) 834-7432
Mailing address
7492 PARKLAND BND, FAIRBURN, GA 30213-5422
(678) 834-7411
(678) 834-7432
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
LDO002220
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GA00314733A
—
GA
Enumeration date
05/07/2014
Last updated
04/10/2020
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