Organization
OPTICA LATINA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONEL E COELLO LDO (OWNER)
(770) 815-1915
Entity
Organization
Contact information
Practice address
4485 LAWRENCEVILLE HWY NW, SUITE 206, LILBURN, GA 30047-3669
(770) 674-1712
(770) 687-2921
Mailing address
4485 LAWRENCEVILLE HWY NW, SUITE 206, LILBURN, GA 30047-3669
(770) 674-1712
(770) 687-2921
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT002681
GA
156FX1800X
Optician
LDO001948
GA
Other
Enumeration date
01/10/2013
Last updated
01/10/2013
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