Provider Demographics
NPI:1154569069
Name:FAMILY EYE CARE CENTER OF ATLANTA, INC
Entity type:Organization
Organization Name:FAMILY EYE CARE CENTER OF ATLANTA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TAKEIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:202-320-7373
Mailing Address - Street 1:1270 CAROLINE ST NE
Mailing Address - Street 2:SUITE D120-377
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2758
Mailing Address - Country:US
Mailing Address - Phone:202-320-7373
Mailing Address - Fax:678-298-9903
Practice Address - Street 1:1400 SOUTHLAKE MALL
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2328
Practice Address - Country:US
Practice Address - Phone:678-422-1936
Practice Address - Fax:678-422-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002490152W00000X, 152WP0200X, 152WS0006X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty