Provider Demographics
NPI:1932397551
Name:GWINNETT OPTICIANS
Entity Type:Organization
Organization Name:GWINNETT OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:MASUEEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-448-6875
Mailing Address - Street 1:5635 PEACHTREE PARKWAY
Mailing Address - Street 2:SUITE 175
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-6400
Mailing Address - Country:US
Mailing Address - Phone:770-448-6875
Mailing Address - Fax:770-449-3091
Practice Address - Street 1:5635 PEACHTREE PARKWAY
Practice Address - Street 2:SUITE 175
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-6400
Practice Address - Country:US
Practice Address - Phone:770-448-6875
Practice Address - Fax:770-449-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5447280001Medicare PIN