Provider Demographics
NPI:1437753860
Name:PRECISION VISION INSTITUTE
Entity Type:Organization
Organization Name:PRECISION VISION INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:URREGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-440-4099
Mailing Address - Street 1:3940 BUFORD HWY STE A104
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3940 BUFORD HWY STE A104
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8212
Practice Address - Country:US
Practice Address - Phone:470-440-4099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1669909701OtherNPPES