Provider Demographics
NPI:1477379709
Name:OLD PIEDMONT EYE GROUP LLC
Entity type:Organization
Organization Name:OLD PIEDMONT EYE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-620-7931
Mailing Address - Street 1:850 OLD PIEDMONT RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-5490
Mailing Address - Country:US
Mailing Address - Phone:770-422-3677
Mailing Address - Fax:770-422-5814
Practice Address - Street 1:850 OLD PIEDMONT RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-5490
Practice Address - Country:US
Practice Address - Phone:770-422-3677
Practice Address - Fax:770-422-5814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-03
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty