Provider Demographics
NPI:1720248669
Name:CLEAR VISION EYE CENTER
Entity type:Organization
Organization Name:CLEAR VISION EYE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-534-2020
Mailing Address - Street 1:1817A CANDLER RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-4162
Mailing Address - Country:US
Mailing Address - Phone:404-534-2020
Mailing Address - Fax:404-534-2025
Practice Address - Street 1:1817A CANDLER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-4162
Practice Address - Country:US
Practice Address - Phone:404-534-2020
Practice Address - Fax:404-534-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA213234302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization