Provider Demographics
NPI:1619274941
Name:BETHEL EYECARE
Entity Type:Organization
Organization Name:BETHEL EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-817-3990
Mailing Address - Street 1:2148 DULUTH HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4504
Mailing Address - Country:US
Mailing Address - Phone:770-817-3990
Mailing Address - Fax:770-817-3991
Practice Address - Street 1:2148 DULUTH HWY STE 102
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4504
Practice Address - Country:US
Practice Address - Phone:770-817-3990
Practice Address - Fax:770-817-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2370152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty