Provider Demographics
NPI:1245418243
Name:FOCAL POINT OPTICAL
Entity Type:Organization
Organization Name:FOCAL POINT OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:MCCOLLUM
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:678-478-8135
Mailing Address - Street 1:1560 INDIAN TRAIL RD
Mailing Address - Street 2:SUITE108
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-2666
Mailing Address - Country:US
Mailing Address - Phone:770-923-1011
Mailing Address - Fax:770-923-1041
Practice Address - Street 1:1560 INDIAN TRAIL RD
Practice Address - Street 2:SUITE108
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2666
Practice Address - Country:US
Practice Address - Phone:770-923-1011
Practice Address - Fax:770-923-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1647152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4765Medicare PIN