Provider Demographics
NPI:1033449046
Name:COMPLETE FAMILY EYECARE AND OPTIQUE PC
Entity Type:Organization
Organization Name:COMPLETE FAMILY EYECARE AND OPTIQUE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYLARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-965-5558
Mailing Address - Street 1:2350 ATLANTA HWY STE 110
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8027
Mailing Address - Country:US
Mailing Address - Phone:678-965-5558
Mailing Address - Fax:678-965-5502
Practice Address - Street 1:2350 ATLANTA HWY STE 110
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8027
Practice Address - Country:US
Practice Address - Phone:678-965-5558
Practice Address - Fax:678-965-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002005152W00000X
GA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty