Provider Demographics
NPI:1871719385
Name:ECA OPTICAL, LLC
Entity type:Organization
Organization Name:ECA OPTICAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-351-2220
Mailing Address - Street 1:3225 CUMBERLAND BLVD SE
Mailing Address - Street 2:STE 800
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5970
Mailing Address - Country:US
Mailing Address - Phone:404-351-2220
Mailing Address - Fax:404-352-5392
Practice Address - Street 1:3225 CUMBERLAND BLVD SE
Practice Address - Street 2:800
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5970
Practice Address - Country:US
Practice Address - Phone:404-351-2220
Practice Address - Fax:404-352-5392
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CONSULTANTS OF ATLANTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6754300001Medicare NSC
GA6754300001Medicare NSC
GA6754300002Medicare NSC
GA4409480004Medicare NSC