Provider Demographics
NPI:1720215775
Name:VILLA RICA EYE CARE
Entity Type:Organization
Organization Name:VILLA RICA EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-941-3357
Mailing Address - Street 1:104 S CARROLL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-2728
Mailing Address - Country:US
Mailing Address - Phone:678-941-3357
Mailing Address - Fax:678-941-3358
Practice Address - Street 1:402 COURTHOUSE SQUARE
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:GA
Practice Address - Zip Code:30113
Practice Address - Country:US
Practice Address - Phone:770-646-9100
Practice Address - Fax:770-646-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002396152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty