Provider Demographics
NPI:1528217213
Name:NORTH OPHTHALMOLOGY REFERRAL CENTER, LLC
Entity Type:Organization
Organization Name:NORTH OPHTHALMOLOGY REFERRAL CENTER, LLC
Other - Org Name:WOOLFSON EYE INSTITUTE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-284-6300
Mailing Address - Street 1:800 MOUNT VERNON HWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4295
Mailing Address - Country:US
Mailing Address - Phone:770-804-1684
Mailing Address - Fax:
Practice Address - Street 1:3925 JOHNS CREEK CT
Practice Address - Street 2:SUITE C
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6618
Practice Address - Country:US
Practice Address - Phone:770-232-7844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty