Provider Demographics
NPI:1801471826
Name:GEORGIA VISION PROFESSIONALS LLC
Entity type:Organization
Organization Name:GEORGIA VISION PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL-VU
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-313-8647
Mailing Address - Street 1:2645 CAROLYN DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2553
Mailing Address - Country:US
Mailing Address - Phone:561-313-8647
Mailing Address - Fax:
Practice Address - Street 1:6435 BELLS FERRY RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-2317
Practice Address - Country:US
Practice Address - Phone:709-264-8107
Practice Address - Fax:770-926-4826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty