Provider Demographics
NPI:1619515707
Name:LUMINARY EYE CARE, LLC
Entity Type:Organization
Organization Name:LUMINARY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JINEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-714-4368
Mailing Address - Street 1:705 TOWN BLVD NE APT 307
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3066
Mailing Address - Country:US
Mailing Address - Phone:334-714-4368
Mailing Address - Fax:
Practice Address - Street 1:1100 JOHNSON FERRY RD STE 120
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2700
Practice Address - Country:US
Practice Address - Phone:334-714-4368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty