Provider Demographics
NPI:1033246533
Name:PACES WEST OPTICIANS INCORPORATED
Entity Type:Organization
Organization Name:PACES WEST OPTICIANS INCORPORATED
Other - Org Name:PACES WEST EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HELMS
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:404-233-6993
Mailing Address - Street 1:3179 MAPLE DR NE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2520
Mailing Address - Country:US
Mailing Address - Phone:404-233-6993
Mailing Address - Fax:404-233-4808
Practice Address - Street 1:2200 NORTHLAKE PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4022
Practice Address - Country:US
Practice Address - Phone:770-938-6690
Practice Address - Fax:770-938-6690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA222156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty