Provider Demographics
NPI:1679794531
Name:VISION INSTITUTE OPTICAL, LLC
Entity type:Organization
Organization Name:VISION INSTITUTE OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-979-1144
Mailing Address - Street 1:2085 MCGEE RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2910
Mailing Address - Country:US
Mailing Address - Phone:770-979-1144
Mailing Address - Fax:770-736-1480
Practice Address - Street 1:3370 SUGARLOAF PKWY
Practice Address - Street 2:SUITE B-3
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-5478
Practice Address - Country:US
Practice Address - Phone:770-339-9100
Practice Address - Fax:770-339-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00493347BMedicaid
GAU20046Medicare UPIN
GA41ZCCQZMedicare ID - Type Unspecified