Provider Demographics
NPI:1629099643
Name:NORTH FULTON OPICAL INC.
Entity Type:Organization
Organization Name:NORTH FULTON OPICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ONEILL
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:770-664-7697
Mailing Address - Street 1:2500 HOSP. BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:770-664-7697
Mailing Address - Fax:770-442-9526
Practice Address - Street 1:2500 HOSPITAL BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4907
Practice Address - Country:US
Practice Address - Phone:770-664-7697
Practice Address - Fax:770-442-9526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20006775082332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0711680001Medicare ID - Type Unspecified