Provider Demographics
NPI:1578795944
Name:MARIETTA EYE CLINIC
Entity Type:Organization
Organization Name:MARIETTA EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:GATEHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-427-8111
Mailing Address - Street 1:895 CANTON RD NE
Mailing Address - Street 2:BLDG 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8934
Mailing Address - Country:US
Mailing Address - Phone:770-427-8111
Mailing Address - Fax:678-803-2591
Practice Address - Street 1:4450 CALIBRE CROSSING, NW.
Practice Address - Street 2:SUITE 1104
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101
Practice Address - Country:US
Practice Address - Phone:678-279-1141
Practice Address - Fax:678-279-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty