Organization
OPTICAL ILLUSIONS, PC
Active
Other names
Vision Source Partners
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IAN BUCHLI O.D. (CEO)
(912) 729-6111
Entity
Organization
Contact information
Practice address
775 C KINGSBAY ROAD, ST MARYS, GA 31558
(912) 729-6111
(912) 729-8595
Mailing address
775 C KINGSBAY ROAD, ST MARYS, GA 31558
(912) 729-6111
(912) 729-8595
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT0001798
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000954291A
—
GA
Enumeration date
01/10/2007
Last updated
11/06/2009
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