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NPI Code Detail

MEDICARE: THOMASVILLE EYE CARE, LLC

MEDICARE: THOMASVILLE EYE CARE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristGA 1210GA

General Provider Information

NPI Number : 1437523826
Entity Type Code : Organization
Provider Name (Legal Business Name) : THOMASVILLE EYE CARE, LLC
Provider Business Mailing Address
First Line : PO BOX 6370
Second Line :
City : THOMASVILLE
State : GA
Zip : 31758-6370
Country : US
Telephone Number : 229-227-1940
Fax Number : 229-227-5629
Provider Business Practice Location Address
First Line : 15328 US HIGHWAY 19 S
Second Line :
City : THOMASVILLE
State : GA
Zip : 31757-4824
Country : US
Telephone Number : 229-227-1940
Fax Number : 229-227-5629
Authorized Official
Title or Position : CEO
Name : DR. DIANA MAURER
Credential : O.D.
Telephone Number : 229-227-1940
Provider Enumeration Date : 11/23/2015
Last Update Date : 11/23/2015

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Directions to “THOMASVILLE EYE CARE, LLC ” Practice Location

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