Provider Demographics
NPI:1982019139
Name:SPECIAL CARE OPTOMETRY OF GEORGIA, LLC
Entity Type:Organization
Organization Name:SPECIAL CARE OPTOMETRY OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELTEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:502-244-2457
Mailing Address - Street 1:12910 SHELBYVILLE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1593
Mailing Address - Country:US
Mailing Address - Phone:502-244-2457
Mailing Address - Fax:502-254-4082
Practice Address - Street 1:3820 PLEASANT HILL RD
Practice Address - Street 2:SUITE 5
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1429
Practice Address - Country:US
Practice Address - Phone:855-259-9183
Practice Address - Fax:502-254-4082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty