1629099643 NPI number — NORTH FULTON OPICAL INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629099643 NPI number — NORTH FULTON OPICAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH FULTON OPICAL INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629099643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 HOSP. BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-664-7697
Provider Business Mailing Address Fax Number:
770-442-9526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 HOSPITAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30076-4907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-664-7697
Provider Business Practice Location Address Fax Number:
770-442-9526
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ONEILL
Authorized Official First Name:
ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTICIAN
Authorized Official Telephone Number:
770-664-7697

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  20006775082 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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