Provider Demographics
NPI:1164695045
Name:VICTORY EYECARE LLC
Entity Type:Organization
Organization Name:VICTORY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KUNLE
Authorized Official - Middle Name:EMMANUEL
Authorized Official - Last Name:OLUWADARE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OD
Authorized Official - Phone:678-482-1324
Mailing Address - Street 1:3592 HUDDLESTONE LN
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4652
Mailing Address - Country:US
Mailing Address - Phone:678-482-1324
Mailing Address - Fax:
Practice Address - Street 1:1342 AUBURN RD
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1140
Practice Address - Country:US
Practice Address - Phone:678-482-1324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002345152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty