Provider Demographics
NPI:1699905075
Name:G3B OPTICAL HOLDINGS, LLC
Entity type:Organization
Organization Name:G3B OPTICAL HOLDINGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:F
Authorized Official - Last Name:JAILLET
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-393-9445
Mailing Address - Street 1:3005 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8594
Mailing Address - Country:US
Mailing Address - Phone:678-393-9445
Mailing Address - Fax:678-298-8503
Practice Address - Street 1:3005 OLD ALABAMA RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8594
Practice Address - Country:US
Practice Address - Phone:678-393-9445
Practice Address - Fax:678-298-8503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT-001864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G415454Medicare PIN