Provider Demographics
NPI:1588960884
Name:NORTH GEORGIA OPTICAL
Entity type:Organization
Organization Name:NORTH GEORGIA OPTICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:OIFER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-998-0331
Mailing Address - Street 1:10775 ALPHARETTA HWY
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:770-998-0331
Mailing Address - Fax:770-998-4634
Practice Address - Street 1:10775 ALPHARETTA HWY
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:770-998-0331
Practice Address - Fax:770-998-4634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0913152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAM01121615Medicare UPIN