Provider Demographics
NPI:1568811610
Name:BELLA OTTICA LLC
Entity Type:Organization
Organization Name:BELLA OTTICA LLC
Other - Org Name:EYES ON TOWNE LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DATTOLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-702-5996
Mailing Address - Street 1:1075 BUCKHEAD XING
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-4262
Mailing Address - Country:US
Mailing Address - Phone:770-702-5996
Mailing Address - Fax:
Practice Address - Street 1:1075 BUCKHEAD XING
Practice Address - Street 2:SUITE 130
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-4262
Practice Address - Country:US
Practice Address - Phone:770-702-5996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001878152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty