Organization
REAGIN OPTOMETRIC GROUP, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALLIS E. REAGIN OD (PRESIDENT)
(404) 378-3694
Entity
Organization
Contact information
Practice address
104 CHURCH ST, DECATUR, GA 30030-3325
(404) 378-3694
(404) 373-0741
Mailing address
104 CHURCH ST, DECATUR, GA 30030-3325
(404) 378-3694
(404) 373-0741
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
486
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00004408A
—
GA
Enumeration date
02/10/2007
Last updated
01/17/2008
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