Provider Demographics
NPI:1902190739
Name:BUCKHEAD VISION INC
Entity Type:Organization
Organization Name:BUCKHEAD VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:DR
Authorized Official - First Name:JAE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-869-5551
Mailing Address - Street 1:4746 LEGACY COVE LN
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2579
Mailing Address - Country:US
Mailing Address - Phone:770-438-0202
Mailing Address - Fax:770-438-5033
Practice Address - Street 1:2900 PEACHTREE RD NW
Practice Address - Street 2:SUITE 301
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-4915
Practice Address - Country:US
Practice Address - Phone:404-869-5551
Practice Address - Fax:404-869-5181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty