Provider Demographics
NPI:1306040944
Name:BULANSEO OPTICAL,INC
Entity Type:Organization
Organization Name:BULANSEO OPTICAL,INC
Other - Org Name:PARIS OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AMI
Authorized Official - Middle Name:JENIEL
Authorized Official - Last Name:PARMAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-559-4004
Mailing Address - Street 1:6035 PEACHTREE RD
Mailing Address - Street 2:SUITE T10
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30360-3230
Mailing Address - Country:US
Mailing Address - Phone:770-559-4004
Mailing Address - Fax:770-559-4228
Practice Address - Street 1:6035 PEACHTREE RD
Practice Address - Street 2:SUITE T10
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30360-3230
Practice Address - Country:US
Practice Address - Phone:770-559-4004
Practice Address - Fax:770-559-4228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002546302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization