Provider Demographics
NPI:1114724077
Name:REFINED VISION THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:REFINED VISION THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMMERETA
Authorized Official - Middle Name:
Authorized Official - Last Name:GASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:404-259-4400
Mailing Address - Street 1:407 TEA ROSE LN N
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-2364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:407 TEA ROSE LN N
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-2364
Practice Address - Country:US
Practice Address - Phone:404-259-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)