Provider Demographics
NPI:1639302441
Name:BROOKS, JAMES G (LDO)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:G
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 REGAS DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-7102
Mailing Address - Country:US
Mailing Address - Phone:702-882-9069
Mailing Address - Fax:770-565-8411
Practice Address - Street 1:3940 REGAS DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7102
Practice Address - Country:US
Practice Address - Phone:702-882-9069
Practice Address - Fax:770-565-8411
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA143958156FC0800X
GA2087156FX1800X
NV351156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens