Provider Demographics
NPI:1902141732
Name:SALLE OPTICIANS INC
Entity Type:Organization
Organization Name:SALLE OPTICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SALLE
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:404-816-6266
Mailing Address - Street 1:3500 PEACHTREE RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1222
Mailing Address - Country:US
Mailing Address - Phone:404-816-6266
Mailing Address - Fax:404-816-8047
Practice Address - Street 1:3500 PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1222
Practice Address - Country:US
Practice Address - Phone:404-816-6266
Practice Address - Fax:404-816-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002713152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty