Organization
EYE SHOP, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DREW PROVOST O.D. (PRESIDENT)
(678) 525-6737
Entity
Organization
Contact information
Practice address
3621 VININGS SLOPE SE, SUITE 4150, ATLANTA, GA 30339-4107
(678) 525-6737
Mailing address
400 W PEACHTREE ST NW, UNIT 2315, ATLANTA, GA 30308-3536
(678) 525-6737
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT 002244
GA
Other
Enumeration date
09/25/2009
Last updated
09/25/2009
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