Provider Demographics
NPI:1679953293
Name:B3 OPTICAL LLC
Entity Type:Organization
Organization Name:B3 OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEPOE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-474-1237
Mailing Address - Street 1:128 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1645
Mailing Address - Country:US
Mailing Address - Phone:770-474-1237
Mailing Address - Fax:770-474-5224
Practice Address - Street 1:550 EALES LANDING PARKWAY
Practice Address - Street 2:SUITE 208
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9082
Practice Address - Country:US
Practice Address - Phone:770-474-1237
Practice Address - Fax:770-474-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty