Provider Demographics
NPI:1780844365
Name:OPTICA FAMILIAR CORP
Entity type:Organization
Organization Name:OPTICA FAMILIAR CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HOSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-388-9912
Mailing Address - Street 1:4166 BUFORD HWY NE
Mailing Address - Street 2:STE R6 ; MB I 10
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1081
Mailing Address - Country:US
Mailing Address - Phone:404-388-9912
Mailing Address - Fax:404-477-0839
Practice Address - Street 1:4166 BUFORD HWY NE
Practice Address - Street 2:STE R6 ; MB I 10
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-1081
Practice Address - Country:US
Practice Address - Phone:404-388-9912
Practice Address - Fax:404-477-0839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001692152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7203Medicare PIN