Healthcare Provider Details

I. General information

NPI: 1205843885
Provider Name (Legal Business Name): EYEAR OPTICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 BATTLEFIELD PKWY
FT OGLETHORPE GA
30742-4009
US

IV. Provider business mailing address

1281 BATTLEFIELD PKWY
FT OGLETHORPE GA
30742-4009
US

V. Phone/Fax

Practice location:
  • Phone: 706-861-7053
  • Fax: 706-861-7810
Mailing address:
  • Phone: 706-861-7053
  • Fax: 706-861-7810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1187
License Number StateGA

VIII. Authorized Official

Name: CINDY C HENDERSON
Title or Position: OWNER
Credential: OPTICIAN
Phone: 706-861-7053