NPI age
19 years
Enumerated 2007-02-12
Across 2375 active optometrist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | OPT002749 | OPTOMETRIC LICENSE |
| 01 (VA) | 0618000681 | TPA OPTOMETRIC LICENSE |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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