Healthcare Provider Details

I. General information

NPI: 1962087270
Provider Name (Legal Business Name): EYE GUYS CAROLINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 INTERSTATE PKWY
AUGUSTA GA
30909-5625
US

IV. Provider business mailing address

1330 INTERSTATE PKWY
AUGUSTA GA
30909-5625
US

V. Phone/Fax

Practice location:
  • Phone: 706-651-3905
  • Fax: 706-651-2032
Mailing address:
  • Phone: 706-651-3905
  • Fax: 706-651-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WENDY BURMEISTER
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-651-2020