Organization
LEGACY FAMILY EYECARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL ROBERTS OD (OWNER)
(770) 887-9171
Entity
Organization
Contact information
Practice address
210 HUDSON ST, CUMMING, GA 30040-2432
(770) 887-9171
(770) 887-9180
Mailing address
210 HUDSON ST, CUMMING, GA 30040-2432
(770) 887-9171
(770) 887-9180
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT001092
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00324816A
—
GA
Enumeration date
10/03/2011
Last updated
04/05/2019
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