Healthcare Provider Details

I. General information

NPI: 1144314998
Provider Name (Legal Business Name): PROFESSIONAL EYE ASSOCIATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

772 MADDOX DR SUITE 132
EAST ELLIJAY GA
30540-8194
US

IV. Provider business mailing address

1111 PROFESSIONAL BLVD
DALTON GA
30720
US

V. Phone/Fax

Practice location:
  • Phone: 706-276-4455
  • Fax: 706-276-4458
Mailing address:
  • Phone: 706-226-2020
  • Fax: 706-217-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA D CURD
Title or Position: COO
Credential:
Phone: 706-226-2020