Provider Demographics
NPI:1740890284
Name:WOODSTOCK EYE ASSOCIATES LLC
Entity type:Organization
Organization Name:WOODSTOCK EYE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANCHITA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DALAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-694-7208
Mailing Address - Street 1:1058 PIEDMONT AVE NE APT 403
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3749
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:113 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7800
Practice Address - Country:US
Practice Address - Phone:770-694-7208
Practice Address - Fax:678-426-8783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty