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Contact Information

CRYSTAL CLEAR OPTIQUE
840 GLYNN ST S STE 344
FAYETTEVILLE, GA30214-2004
 Phone: 770-716-7414
 Fax: 770-716-7498
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
 

Contact Lens

156FC0800X
 

Optician

156FX1800X 96[5] Optician
 

Vision Therapy

152WV0400X 41 Optometry
Indicates primary specialty

NPI Profile & details for CRYSTAL CLEAR OPTIQUE

NPI Number 1255927240
LBN Legal business name CRYSTAL CLEAR OPTIQUE
Authorized official CRYSTAL WADE - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 12/14/2020
Last updated 12/14/2020 - About 5 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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