Provider Demographics
NPI:1548595507
Name:MARIETTA VISION
Entity type:Organization
Organization Name:MARIETTA VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LOD
Authorized Official - Phone:770-792-0208
Mailing Address - Street 1:397 N SESSIONS ST NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1325
Mailing Address - Country:US
Mailing Address - Phone:770-792-0208
Mailing Address - Fax:
Practice Address - Street 1:397 N SESSIONS ST NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1325
Practice Address - Country:US
Practice Address - Phone:770-792-0208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIETTA CONTACTS LENS SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000867156FC0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Single Specialty