| |
2948 Five Forks Trickum Rd, Suite C, Lawrenceville, GA 30044-5872 | |
(770) 736-7774 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Technician/technologist - Optician |
Location | 2948 Five Forks Trickum Rd, Lawrenceville, Georgia |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1437279569 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | GA0832 (Georgia) | Primary |
156FX1800X | Technician/technologist - Optician | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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2948 Five Forks Trickum Rd, Suite C, Lawrenceville, GA 30044-5872 Ph: (770) 736-7774 | 2948 Five Forks Trickum Rd, Suite C, Lawrenceville, GA 30044-5872 Ph: (770) 736-7774 |