Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Fayette Medical Clinic Optical Shop

Organization Ophthalmology Physician · NPI 1891910618

Fayette Medical Clinic Optical Shop is an Ophthalmology Physician in Fayetteville, Georgia. Licensed in Georgia. Registered with an NPI since 2007.

Licensed in
GA
In the registry since
2007

Practice location Address checks out

101 Yorktown Dr Ste 225
Fayetteville, GA 30214-1568
Phone: (770) 460-2331
Fax: (770) 460-4016
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Ophthalmology Physician (primary) Taxonomy 207W00000X · Licence 20001558 (GA)

Record details

NPI number1891910618
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Rick Rodecker — Administrator · (404) 351-2220
NPI enumeratedApril 16, 2007
Last updated in NPPESJune 3, 2021
Certification dateJune 3, 2021
Mailing address101 Yorktown Dr Ste 225, Fayetteville, GA 30214-1568

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