Provider Demographics
NPI:1861728800
Name:BELLA VISTA FAMILY EYECARE
Entity type:Organization
Organization Name:BELLA VISTA FAMILY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-819-4981
Mailing Address - Street 1:3142 BRIANS CREEK DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6437
Mailing Address - Country:US
Mailing Address - Phone:770-819-4981
Mailing Address - Fax:770-819-9039
Practice Address - Street 1:1100 THORNTON RD
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2616
Practice Address - Country:US
Practice Address - Phone:770-819-4981
Practice Address - Fax:770-819-9039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4189152W00000X
GAOPT002269152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty