Provider Demographics
NPI:1417477902
Name:WOODSTOCK OPTOMETRY, P.C.
Entity Type:Organization
Organization Name:WOODSTOCK OPTOMETRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CHAO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-556-7656
Mailing Address - Street 1:5947 HOLLY SPRINGS PKWY STE 305
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-2449
Mailing Address - Country:US
Mailing Address - Phone:404-556-7656
Mailing Address - Fax:
Practice Address - Street 1:915 RIDGEWALK PKWY STE 425
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-0119
Practice Address - Country:US
Practice Address - Phone:770-592-7413
Practice Address - Fax:770-516-6797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002756152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty