Organization
LIL' EYEWEAR OUTLET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK ALFRED ABO CERTIFIED (LAB MANAGER)
(770) 719-9500
Entity
Organization
Contact information
Practice address
120 GEORGIA AVE E, FAYETTEVILLE, GA 30214-1616
(770) 719-9500
(770) 719-9500
Mailing address
120 GEORGIA AVE E, FAYETTEVILLE, GA 30214-1616
(770) 719-9500
(770) 719-9500
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1621
GA
Other
Enumeration date
11/04/2011
Last updated
11/04/2011
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