Provider Demographics
NPI:1669929634
Name:TOWN CENTER VISION CARE, LLC
Entity type:Organization
Organization Name:TOWN CENTER VISION CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CMO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-725-6171
Mailing Address - Street 1:200 ASHFORD CTR N STE 305
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-2682
Mailing Address - Country:US
Mailing Address - Phone:770-727-0772
Mailing Address - Fax:770-766-1117
Practice Address - Street 1:400 ERNEST W BARRETT PKWY NW STE 617
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4997
Practice Address - Country:US
Practice Address - Phone:770-727-0772
Practice Address - Fax:770-766-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA12793431OtherCAQH