Healthcare Provider Details

I. General information

NPI: 1720105273
Provider Name (Legal Business Name): ERIC T. KINARD, O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1137 CEDAR SHOALS DR
ATHENS GA
30605-3592
US

IV. Provider business mailing address

1137 CEDAR SHOALS DR
ATHENS GA
30605-3592
US

V. Phone/Fax

Practice location:
  • Phone: 706-353-2119
  • Fax:
Mailing address:
  • Phone: 706-353-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number933
License Number StateGA

VIII. Authorized Official

Name: DR. ERIC TEAL KINARD
Title or Position: PRESIDENT
Credential: OD
Phone: 706-353-2119