Provider Demographics
NPI:1205056173
Name:PINNACLE EYECARE PROFESSIONALS
Entity type:Organization
Organization Name:PINNACLE EYECARE PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KWONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-979-2198
Mailing Address - Street 1:1520 SCENIC HWY N
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2130
Mailing Address - Country:US
Mailing Address - Phone:917-517-9488
Mailing Address - Fax:
Practice Address - Street 1:1520 SCENIC HWY N
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2130
Practice Address - Country:US
Practice Address - Phone:770-979-2198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1934152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty