Provider Demographics
NPI:1972533156
Name:LENOX EYE ASSOC PC
Entity Type:Organization
Organization Name:LENOX EYE ASSOC PC
Other - Org Name:OPTICA UNIVERSAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SORROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-320-9100
Mailing Address - Street 1:2369 BUFORD HIGHWAY
Mailing Address - Street 2:SUITE 820
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329
Mailing Address - Country:US
Mailing Address - Phone:404-320-9100
Mailing Address - Fax:404-239-0298
Practice Address - Street 1:1418 DRESDEN DRIVE
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-842-1950
Practice Address - Fax:404-239-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001104152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA348726036BMedicaid
GA41ZCBDZMedicare ID - Type Unspecified
GA348726036BMedicaid