Provider Demographics
NPI:1306369806
Name:REDUS OPTOMETRY CLINIC LLC
Entity Type:Organization
Organization Name:REDUS OPTOMETRY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:REDUS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-327-0111
Mailing Address - Street 1:3507 MANCHESTER EXPY
Mailing Address - Street 2:#92
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909
Mailing Address - Country:US
Mailing Address - Phone:706-327-0111
Mailing Address - Fax:706-329-4980
Practice Address - Street 1:3507 MANCHESTER EXPY
Practice Address - Street 2:#92
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909
Practice Address - Country:US
Practice Address - Phone:706-327-0111
Practice Address - Fax:706-327-4980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001566152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty