Provider Demographics
NPI:1346668662
Name:ECA OPTICAL, LLC
Entity Type:Organization
Organization Name:ECA OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-351-2220
Mailing Address - Street 1:3225 CUMBERLAND BLVD SE
Mailing Address - Street 2:900
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6407
Mailing Address - Country:US
Mailing Address - Phone:404-351-2220
Mailing Address - Fax:404-352-5392
Practice Address - Street 1:601-A PROFESSIONAL DRIVE, STE 170
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045
Practice Address - Country:US
Practice Address - Phone:678-323-1041
Practice Address - Fax:770-962-0012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CONSUTLANTS OF ATLANTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-03
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier