Healthcare Provider Details

I. General information

NPI: 1225086721
Provider Name (Legal Business Name): AUGUSTA EYE MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 STEVENS CREEK RD STE A
AUGUSTA GA
30907-3201
US

IV. Provider business mailing address

905 STEVENS CREEK RD STE A
AUGUSTA GA
30907-3201
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-6000
  • Fax: 706-722-7994
Mailing address:
  • Phone: 706-922-6000
  • Fax: 706-722-7994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: STUART D. MARKS
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 706-922-6000