Provider Demographics
NPI:1205057437
Name:EYE Q VISION CARE
Entity type:Organization
Organization Name:EYE Q VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-208-2393
Mailing Address - Street 1:546 LAKELAND PLAZA
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2782
Mailing Address - Country:US
Mailing Address - Phone:678-208-2393
Mailing Address - Fax:678-208-0851
Practice Address - Street 1:546 LAKELAND PLAZA
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2782
Practice Address - Country:US
Practice Address - Phone:678-208-2393
Practice Address - Fax:678-208-0851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02111152W00000X
GA001232152W00000X
GAOPT001232152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty