Provider Demographics
NPI:1649411950
Name:BRICE, MARY ELIZABETH FARRAR (OD)
Entity Type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:FARRAR
Last Name:BRICE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 MT. VERNON ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338
Mailing Address - Country:US
Mailing Address - Phone:770-396-3460
Mailing Address - Fax:770-668-0436
Practice Address - Street 1:1637 MT. VERNON ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338
Practice Address - Country:US
Practice Address - Phone:770-396-3460
Practice Address - Fax:770-668-0436
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002471152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist