Provider Demographics
NPI:1295036556
Name:T.J. VISION
Entity type:Organization
Organization Name:T.J. VISION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:KEMENG
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-234-9249
Mailing Address - Street 1:5150 BUFORD HWY NE STE D120
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-1170
Mailing Address - Country:US
Mailing Address - Phone:770-234-9249
Mailing Address - Fax:
Practice Address - Street 1:5150 BUFORD HWY NE STE D120
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-1170
Practice Address - Country:US
Practice Address - Phone:770-234-9249
Practice Address - Fax:770-234-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAINV-1-10-13161152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty