Provider Demographics
NPI:1457782641
Name:GAINESVILLE VISION
Entity Type:Organization
Organization Name:GAINESVILLE VISION
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:770-532-2176
Mailing Address - Street 1:890 DAWSONVILLE HWY STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:770-532-2176
Mailing Address - Fax:770-532-3906
Practice Address - Street 1:890 DAWSONVILLE HWY STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2608
Practice Address - Country:US
Practice Address - Phone:770-532-2176
Practice Address - Fax:770-532-3906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001279332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier