Provider Demographics
NPI:1003255597
Name:P&D FAMILY, LLC
Entity Type:Organization
Organization Name:P&D FAMILY, LLC
Other - Org Name:EYEDEOLOGY VISION CENTER & OPTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DIVYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-778-1985
Mailing Address - Street 1:860 PEACHTREE ST NE
Mailing Address - Street 2:SUITE F
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1249
Mailing Address - Country:US
Mailing Address - Phone:404-853-5008
Mailing Address - Fax:404-853-5009
Practice Address - Street 1:860 PEACHTREE ST NE
Practice Address - Street 2:SUITE F
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1249
Practice Address - Country:US
Practice Address - Phone:404-853-5008
Practice Address - Fax:404-853-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002708152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty