Provider Demographics
NPI:1174716740
Name:BRIGGS VISION GROUP, P.C.
Entity type:Organization
Organization Name:BRIGGS VISION GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:TURNER
Authorized Official - Last Name:DERISO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-396-3460
Mailing Address - Street 1:1637 MOUNT VERNON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1637 MOUNT VERNON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4205
Practice Address - Country:US
Practice Address - Phone:770-396-3460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1785Medicare PIN