Organization
EYE MAZ N EYE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ECCLESIA LUCIANA GRANT LDO (LDO/OWNER)
(404) 432-1772
Entity
Organization
Contact information
Practice address
5534 OLD NATIONAL HWY, SUITE B-100, COLLEGE PARK, GA 30349-3212
(404) 432-1772
Mailing address
165 HIDDEN BROOK CT, ATLANTA, GA 30349-4440
(404) 432-1772
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LDO 002273
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437476868
ECCLESIA LUCIANA GRANT
GA
Enumeration date
09/27/2010
Last updated
09/27/2010
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