Provider Demographics
NPI:1124189113
Name:S P D OPTICAL INC
Entity Type:Organization
Organization Name:S P D OPTICAL INC
Other - Org Name:AMERICAN VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:706-543-7925
Mailing Address - Street 1:3700 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3700 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7201
Practice Address - Country:US
Practice Address - Phone:706-543-7925
Practice Address - Fax:706-546-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001503332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0234640002OtherMEDICARE NSC
GA0234640002Medicare NSC