Provider Demographics
NPI:1770904427
Name:PIERRE, PAMELA (OD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:PIERRE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8075 MALL PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6993
Mailing Address - Country:US
Mailing Address - Phone:770-484-2955
Mailing Address - Fax:770-484-2954
Practice Address - Street 1:8075 MALL PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-6993
Practice Address - Country:US
Practice Address - Phone:770-484-2955
Practice Address - Fax:770-484-2954
Is Sole Proprietor?:No
Enumeration Date:2013-12-26
Last Update Date:2014-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002797152W00000X
PAOEG002880152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist