Provider Demographics
NPI:1447425129
Name:JOHN C.VENCILL O.D., P.C.
Entity Type:Organization
Organization Name:JOHN C.VENCILL O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:VENCILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-485-8906
Mailing Address - Street 1:2933 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-6252
Mailing Address - Country:US
Mailing Address - Phone:678-485-8906
Mailing Address - Fax:770-222-6691
Practice Address - Street 1:1400 HUDSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5018
Practice Address - Country:US
Practice Address - Phone:678-485-8906
Practice Address - Fax:770-474-0698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty