Provider Demographics
NPI:1134426356
Name:MIDTOWN OPTICAL INC
Entity type:Organization
Organization Name:MIDTOWN OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-897-5767
Mailing Address - Street 1:650 PONCE DE LEON AVE NE
Mailing Address - Street 2:SUITE 630A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1804
Mailing Address - Country:US
Mailing Address - Phone:404-897-5767
Mailing Address - Fax:404-897-3839
Practice Address - Street 1:650 PONCE DE LEON AVE NE
Practice Address - Street 2:SUITE 630A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1804
Practice Address - Country:US
Practice Address - Phone:404-897-5767
Practice Address - Fax:404-897-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1371T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty