Organization
NATIONAL OPTIC PROVIDER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID WILLIAMS (OFFICE MANAGER)
(404) 344-3337
Entity
Organization
Contact information
Practice address
2740 GREENBRIAR PKWY SW, SUITE A-3, ATLANTA, GA 30331-2627
(404) 344-3337
Mailing address
2740 GREENBRIAR PKWY SW, SUITE A-3, ATLANTA, GA 30331-2627
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
OPTOO1375
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101529
AVESIS
GA
01
—
40387
BCBS OF GA
GA
01
—
GE43177
SPECTERA
GA
Enumeration date
04/12/2007
Last updated
08/22/2020
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