Provider Demographics
NPI:1902433691
Name:DECATUR EYE CARE
Entity Type:Organization
Organization Name:DECATUR EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:BRILLANTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-550-6779
Mailing Address - Street 1:321 W HILL ST STE 6
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4362
Mailing Address - Country:US
Mailing Address - Phone:404-371-8777
Mailing Address - Fax:404-371-9384
Practice Address - Street 1:321 W HILL ST STE 6
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4362
Practice Address - Country:US
Practice Address - Phone:404-371-8777
Practice Address - Fax:404-371-9384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty