| Organization Name: | OPTICAL SHOP AT ATHENS EYE ASSOCIATES, INC. |
| NPI Number: | 1407094261 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL S. JACOBS (PRESIDENT) |
| Mailing Address: | 1080 Vend Dr Suite 100 Bogart |
| State: | GA US |
| Postal Code: | 306223051 |
| Phone Number: | 7065497047 |
| Fax Number: | 7066135395 |
| NPI Enumeration Date: | 01/31/2009 |
| NPI Last Update Date: | 08/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332H00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |