Provider Demographics
NPI:1700675568
Name:MARIETTA EYE CLINIC PA
Entity type:Organization
Organization Name:MARIETTA EYE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, CFO TPR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RASMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2532
Mailing Address - Street 1:PO BOX 96837
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28296-6837
Mailing Address - Country:US
Mailing Address - Phone:678-439-2450
Mailing Address - Fax:
Practice Address - Street 1:4025 JOHNS CREEK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-5683
Practice Address - Country:US
Practice Address - Phone:678-439-2450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty