Provider Demographics
NPI:1871971861
Name:EYEDEAL VISION GROUP LLC
Entity type:Organization
Organization Name:EYEDEAL VISION GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-703-2466
Mailing Address - Street 1:2650 HOLCOMB BRIDGE RD
Mailing Address - Street 2:STE 510
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5333
Mailing Address - Country:US
Mailing Address - Phone:314-703-2466
Mailing Address - Fax:
Practice Address - Street 1:1922 JOHNSON FERRY RD NE
Practice Address - Street 2:UNIT E
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-5003
Practice Address - Country:US
Practice Address - Phone:314-703-2466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002653152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty