Provider Demographics
NPI:1720443401
Name:EYEDREAM EYECARE, LLC
Entity type:Organization
Organization Name:EYEDREAM EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-267-5843
Mailing Address - Street 1:7774 MCGINNIS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1622
Mailing Address - Country:US
Mailing Address - Phone:678-540-4772
Mailing Address - Fax:678-540-4752
Practice Address - Street 1:7774 MCGINNIS FERRY RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1622
Practice Address - Country:US
Practice Address - Phone:678-540-4772
Practice Address - Fax:678-540-4752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002343152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty