Provider Demographics
NPI:1073658639
Name:ATLANTA EYE CARE
Entity Type:Organization
Organization Name:ATLANTA EYE CARE
Other - Org Name:CUMBERLAND POINTE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:LDO OPTICIAN
Authorized Official - Phone:404-274-6805
Mailing Address - Street 1:3155 COBB PKWY
Mailing Address - Street 2:STE 110
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339
Mailing Address - Country:US
Mailing Address - Phone:770-644-0012
Mailing Address - Fax:770-644-0091
Practice Address - Street 1:3155 COBB PKWY
Practice Address - Street 2:STE 110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339
Practice Address - Country:US
Practice Address - Phone:770-644-0012
Practice Address - Fax:770-644-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700368Medicare PIN