Basic Information
Provider Information | |||||||||
NPI: | 1518263540 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | AMERICA'S BEST CONTACTS & EYEGLASSES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 296 GRAYSON HWY | ||||||||
Address2: |   | ||||||||
City: | LAWRENCEVILLE | ||||||||
State: | GA | ||||||||
PostalCode: | 300465737 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7708223600 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 735 DOMINION SQ SHOPPING CTR | ||||||||
Address2: |   | ||||||||
City: | CULPEPER | ||||||||
State: | VA | ||||||||
PostalCode: | 227012479 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5404236601 | ||||||||
FaxNumber: | 5404236606 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/09/2011 | ||||||||
LastUpdateDate: | 02/09/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | EDICK | ||||||||
AuthorizedOfficialFirstName: | SUSAN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | MC ASSISTANT | ||||||||
AuthorizedOfficialTelephone: | 6788923774 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | NATIONAL VISION INC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.