Provider Demographics
NPI:1013312453
Name:LAKE LANIER EYE CARE, LLC
Entity Type:Organization
Organization Name:LAKE LANIER EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-910-0735
Mailing Address - Street 1:205 HIGHLAND GATE CIR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1795
Mailing Address - Country:US
Mailing Address - Phone:662-910-0735
Mailing Address - Fax:
Practice Address - Street 1:5885 CUMMING HWY STE 401-402
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-5765
Practice Address - Country:US
Practice Address - Phone:678-926-3525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty