Healthcare Provider Details

I. General information

NPI: 1639775588
Provider Name (Legal Business Name): EAST ATHENS FAMILY VISION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 GAINES SCHOOL RD
ATHENS GA
30605-3132
US

IV. Provider business mailing address

270 HAWTHORNE AVE
ATHENS GA
30606-2881
US

V. Phone/Fax

Practice location:
  • Phone: 706-850-7101
  • Fax: 706-850-7089
Mailing address:
  • Phone: 706-850-7101
  • Fax: 706-850-7089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RUSSELL DOUGLAS SPRINGER
Title or Position: OWNER
Credential: OD
Phone: 706-543-3599