Provider Demographics
NPI:1598375156
Name:MARIETTA EYE OPTICAL INC
Entity Type:Organization
Organization Name:MARIETTA EYE OPTICAL INC
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 BLDG 100
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8935
Mailing Address - Country:US
Mailing Address - Phone:770-427-8111
Mailing Address - Fax:770-499-1643
Practice Address - Street 1:10485 ALPHARETTA ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3757
Practice Address - Country:US
Practice Address - Phone:678-439-2443
Practice Address - Fax:470-395-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies