Provider Demographics
NPI:1760614259
Name:ATLANTA VISION OPTICAL
Entity Type:Organization
Organization Name:ATLANTA VISION OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GHAZAL
Authorized Official - Middle Name:
Authorized Official - Last Name:TABRIZIPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-522-8886
Mailing Address - Street 1:1215 CAROLINE ST NE
Mailing Address - Street 2:SUITE H-100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2775
Mailing Address - Country:US
Mailing Address - Phone:404-522-8886
Mailing Address - Fax:404-522-8887
Practice Address - Street 1:1215 CAROLINE ST NE
Practice Address - Street 2:SUITE H-100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-2775
Practice Address - Country:US
Practice Address - Phone:404-522-8886
Practice Address - Fax:404-522-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty