Provider Demographics
NPI:1134945447
Name:VISIONARY DRY EYE INSTITUTE
Entity type:Organization
Organization Name:VISIONARY DRY EYE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-428-0414
Mailing Address - Street 1:2550 WINDY HILL RD SE STE 320
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8655
Mailing Address - Country:US
Mailing Address - Phone:770-428-0414
Mailing Address - Fax:770-428-0415
Practice Address - Street 1:2550 WINDY HILL RD SE STE 320
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8655
Practice Address - Country:US
Practice Address - Phone:770-428-0414
Practice Address - Fax:770-428-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty