Organization
B.SPECTACLED-SUWANEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES DYKEMAN (PRESIDENT)
(404) 386-0295
Entity
Organization
Contact information
Practice address
991 PEACHTREE INDUSTRIAL BLVD STE 114, SUWANEE, GA 30024-4343
(770) 904-0883
(678) 765-0976
Mailing address
991 PEACHTREE INDUSTRIAL BLVD STE 114, SUWANEE, GA 30024-4343
(770) 904-0883
(678) 765-0976
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT002878
GA
Other
Enumeration date
08/03/2018
Last updated
01/20/2022
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