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Organization

MOBLEY RIVERDALE EYE CLINIC INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
B. DEAN MOBLEY OD (OWNER / OD)
(678) 817-7722
Entity
Organization

Contact information

Practice address
539 GLYNN ST N, SUITE A, FAYETTEVILLE, GA 30214-1108
(678) 817-7722
(678) 817-0067
Mailing address
539 GLYNN ST N, SUITE A, FAYETTEVILLE, GA 30214-1108
(678) 817-7722
(678) 817-0067

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
912T
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00214629C
GA
Enumeration date
03/17/2008
Last updated
09/12/2011
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