Basic Information
Provider Information
NPI: 1366710113
EntityType: 2
ReplacementNPI:  
OrganizationName: AMERICA'S BEST CONTACTS & EYEGLASSES
LastName:  
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Mailing Information
Address1: 296 GRAYSON HWY
Address2:  
City: LAWRENCEVILLE
State: GA
PostalCode: 300465737
CountryCode: US
TelephoneNumber: 7708223600
FaxNumber:  
Practice Location
Address1: 1121 BOARDMAN ROAD
Address2:  
City: JACKSON
State: MI
PostalCode: 492021901
CountryCode: US
TelephoneNumber: 5177835344
FaxNumber: 5177835326
Other Information
ProviderEnumerationDate: 12/08/2011
LastUpdateDate: 12/08/2011
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: EDICK
AuthorizedOfficialFirstName: SUSAN
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AuthorizedOfficialTitleorPosition: MC ASST
AuthorizedOfficialTelephone: 6788923774
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: NATIONAL VISION INC.
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
156FX1800X  Y193400000X SINGLE SPECIALTY GROUPEye and Vision Services ProvidersTechnician/TechnologistOptician

No ID Information.


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