Provider Demographics
NPI:1871922385
Name:DORFZAUN EYE GROUP,L.L.C.
Entity type:Organization
Organization Name:DORFZAUN EYE GROUP,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:DORFZAUN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-422-3677
Mailing Address - Street 1:850 OLD PIEDMONT RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-5490
Mailing Address - Country:US
Mailing Address - Phone:770-422-3677
Mailing Address - Fax:770-422-5814
Practice Address - Street 1:850 OLD PIEDMONT RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-5490
Practice Address - Country:US
Practice Address - Phone:770-422-3677
Practice Address - Fax:770-422-5814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU22702Medicare UPIN