Provider Demographics
NPI:1619415718
Name:GOH VISION
Entity Type:Organization
Organization Name:GOH VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ADELINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-720-7721
Mailing Address - Street 1:2400 N DRUID HILLS RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3211
Mailing Address - Country:US
Mailing Address - Phone:404-720-7721
Mailing Address - Fax:
Practice Address - Street 1:2400 N DRUID HILLS RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3211
Practice Address - Country:US
Practice Address - Phone:404-720-7721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002903152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty