Provider Demographics
NPI:1225333040
Name:EYEWORKS GA, LLC
Entity Type:Organization
Organization Name:EYEWORKS GA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:404-377-3937
Mailing Address - Street 1:335 W PONCE DE LEON AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2451
Mailing Address - Country:US
Mailing Address - Phone:404-377-3937
Mailing Address - Fax:404-377-3936
Practice Address - Street 1:335 W PONCE DE LEON AVE
Practice Address - Street 2:SUITE F
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2451
Practice Address - Country:US
Practice Address - Phone:404-377-3937
Practice Address - Fax:404-377-3936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLDO002182152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty