Provider Demographics
NPI:1083931950
Name:PARKWAY FAMILY OPTICAL
Entity Type:Organization
Organization Name:PARKWAY FAMILY OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:SCHERRELLE
Authorized Official - Last Name:BYNUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-366-9822
Mailing Address - Street 1:530 FOREST PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-2188
Mailing Address - Country:US
Mailing Address - Phone:404-366-9822
Mailing Address - Fax:404-608-8591
Practice Address - Street 1:530 FOREST PKWY STE D
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-2188
Practice Address - Country:US
Practice Address - Phone:404-366-9822
Practice Address - Fax:404-608-8591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty