Provider Demographics
NPI:1205930666
Name:ATLANTA EYE CENTER, LLC
Entity type:Organization
Organization Name:ATLANTA EYE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAHARJA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-656-6305
Mailing Address - Street 1:4717 CAMBRIDGE TRCE
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5252
Mailing Address - Country:US
Mailing Address - Phone:678-656-6305
Mailing Address - Fax:
Practice Address - Street 1:1801 HOWELL MILL RD
Practice Address - Street 2:WAL-MART VISION CENTER #3775
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318
Practice Address - Country:US
Practice Address - Phone:404-352-3414
Practice Address - Fax:404-352-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT2319152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty