Provider Demographics
NPI:1629109186
Name:MEDICAL CONCEPTS IN VISION
Entity Type:Organization
Organization Name:MEDICAL CONCEPTS IN VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:F
Authorized Official - Last Name:HUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:770-263-7060
Mailing Address - Street 1:724 HOLCOMB BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1325
Mailing Address - Country:US
Mailing Address - Phone:770-263-7060
Mailing Address - Fax:770-840-0901
Practice Address - Street 1:724 HOLCOMB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1325
Practice Address - Country:US
Practice Address - Phone:770-263-7060
Practice Address - Fax:770-840-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO001172156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1114450001Medicare ID - Type Unspecified