Provider Demographics
NPI:1205009669
Name:INTOWN OPTICS INC
Entity Type:Organization
Organization Name:INTOWN OPTICS INC
Other - Org Name:COLONY SQUARE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-874-0874
Mailing Address - Street 1:1197 PEACHTREE ST NE
Mailing Address - Street 2:STE 520
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30361-3502
Mailing Address - Country:US
Mailing Address - Phone:404-874-0874
Mailing Address - Fax:404-872-5216
Practice Address - Street 1:1197 PEACHTREE ST NE
Practice Address - Street 2:STE 520
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30361-3502
Practice Address - Country:US
Practice Address - Phone:404-874-0874
Practice Address - Fax:404-872-5216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001339152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAY08452Medicare UPIN
GA41ZCFNCMedicare PIN