NPI age
14 years
Enumerated 2011-06-29
Across 2375 active optometrist providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 003112940A | |
| 01 | 581787543 | FEIN |
Part of a multi-provider practice. 10 other active providers share this practice address in NPPES.
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