Provider Demographics
NPI:1306061114
Name:ECA OPTICAL, LLC
Entity type:Organization
Organization Name:ECA OPTICAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:RODECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-351-2220
Mailing Address - Street 1:3225 CUMBERLAND BLVD SE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6407
Mailing Address - Country:US
Mailing Address - Phone:404-351-2220
Mailing Address - Fax:404-352-5392
Practice Address - Street 1:355 TOWER RD NE
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9408
Practice Address - Country:US
Practice Address - Phone:770-424-5669
Practice Address - Fax:770-424-8454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CONSULTANTS OF ATLANTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-16
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002052332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4409480004Medicare NSC