Provider Demographics
NPI:1821347907
Name:PUREVUE VISION CARE, LLC
Entity Type:Organization
Organization Name:PUREVUE VISION CARE, LLC
Other - Org Name:FOCUS VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NHAT ANH
Authorized Official - Middle Name:THI
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-903-4555
Mailing Address - Street 1:6050 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3336
Mailing Address - Country:US
Mailing Address - Phone:770-903-4555
Mailing Address - Fax:770-903-4556
Practice Address - Street 1:6050 PEACHTREE PARKWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092
Practice Address - Country:US
Practice Address - Phone:678-557-1860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002172152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA#003114597CMedicaid
GA#003114597CMedicaid