Provider Demographics
NPI:1801279351
Name:VISIONCRAFTERS OPTICAL GROUP LLC
Entity type:Organization
Organization Name:VISIONCRAFTERS OPTICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:678-621-8271
Mailing Address - Street 1:4202 CALLAWAN CT
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-1675
Mailing Address - Country:US
Mailing Address - Phone:770-873-0601
Mailing Address - Fax:
Practice Address - Street 1:1750 POWDER SPRINGS RD SW STE 210
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4848
Practice Address - Country:US
Practice Address - Phone:678-621-8271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002633332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier