Provider Demographics
NPI:1679240402
Name:MAGGIE MOOO LLC
Entity Type:Organization
Organization Name:MAGGIE MOOO LLC
Other - Org Name:UPTOWN EYE BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-320-8059
Mailing Address - Street 1:9700 MEDLOCK BRIDGE RD STE 120B
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4408
Mailing Address - Country:US
Mailing Address - Phone:248-320-8059
Mailing Address - Fax:
Practice Address - Street 1:9700 MEDLOCK BRIDGE RD STE 120B
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-4408
Practice Address - Country:US
Practice Address - Phone:770-558-1850
Practice Address - Fax:678-691-8056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-28
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty