Provider Demographics
NPI:1790197366
Name:SUSAN REIMBOLD O.D., P.C.
Entity Type:Organization
Organization Name:SUSAN REIMBOLD O.D., P.C.
Other - Org Name:REIMBOLD EYE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REIMBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-776-9000
Mailing Address - Street 1:4180 OLD MILTON PKWY
Mailing Address - Street 2:SUITE 1-D
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2408
Mailing Address - Country:US
Mailing Address - Phone:770-776-9000
Mailing Address - Fax:
Practice Address - Street 1:4180 OLD MILTON PKWY
Practice Address - Street 2:SUITE 1-D
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2408
Practice Address - Country:US
Practice Address - Phone:770-776-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA001567152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty