Provider Demographics
NPI:1487381380
Name:ITHERAPY
Entity type:Organization
Organization Name:ITHERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATERIN
Authorized Official - Middle Name:AWILDA
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-446-0343
Mailing Address - Street 1:2250 MARIETTA BLVD NW
Mailing Address - Street 2:STE 302
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318
Mailing Address - Country:US
Mailing Address - Phone:404-446-0343
Mailing Address - Fax:404-446-0344
Practice Address - Street 1:2250 MARIETTA BOULEVARD NORTHWEST
Practice Address - Street 2:SUITE 302
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2020
Practice Address - Country:US
Practice Address - Phone:404-446-0343
Practice Address - Fax:404-446-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty