Provider Demographics
NPI:1750654141
Name:MAP EYES LLC
Entity Type:Organization
Organization Name:MAP EYES LLC
Other - Org Name:EYES ON PROVIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-560-8065
Mailing Address - Street 1:3535 ROSWELL RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8826
Mailing Address - Country:US
Mailing Address - Phone:678-560-8065
Mailing Address - Fax:
Practice Address - Street 1:3535 ROSWELL RD
Practice Address - Street 2:SUITE 8
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8826
Practice Address - Country:US
Practice Address - Phone:678-560-8065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20G2701660Medicare PIN