Provider Demographics
NPI:1881383024
Name:VISIONARY EYECARE OF ATLANTA, LLC
Entity type:Organization
Organization Name:VISIONARY EYECARE OF ATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-399-0716
Mailing Address - Street 1:2311 CASCADE RD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-3201
Mailing Address - Country:US
Mailing Address - Phone:404-549-9996
Mailing Address - Fax:
Practice Address - Street 1:2311 CASCADE RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-3201
Practice Address - Country:US
Practice Address - Phone:404-549-9996
Practice Address - Fax:404-829-1368
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISIONARY EYECARE OF ATLANTA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty