Provider Demographics
NPI:1932419942
Name:BROOKHAVEN EYE CARE INC.
Entity Type:Organization
Organization Name:BROOKHAVEN EYE CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HSU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-460-1928
Mailing Address - Street 1:500 BROOKHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319
Mailing Address - Country:US
Mailing Address - Phone:404-460-1928
Mailing Address - Fax:404-460-1929
Practice Address - Street 1:500 BROOKHAVEN AVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319
Practice Address - Country:US
Practice Address - Phone:404-460-1928
Practice Address - Fax:404-460-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2240152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty