Provider Demographics
NPI:1912225426
Name:VISION EXCLUSIVE LLC
Entity Type:Organization
Organization Name:VISION EXCLUSIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FUNMILAYO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARANMOLATE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-360-0143
Mailing Address - Street 1:7043 PERIMETER TRCE E
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-1923
Mailing Address - Country:US
Mailing Address - Phone:678-360-0143
Mailing Address - Fax:
Practice Address - Street 1:2625 PEACHTREE PKWY
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1048
Practice Address - Country:US
Practice Address - Phone:678-965-5792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2502152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty