Healthcare Provider Details

I. General information

NPI: 1508916701
Provider Name (Legal Business Name): EYECARE ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 JESSE JEWELL PKWY SE
GAINESVILLE GA
30501-3823
US

IV. Provider business mailing address

1276 JESSE JEWELL PKWY SE
GAINESVILLE GA
30501-3823
US

V. Phone/Fax

Practice location:
  • Phone: 770-532-7246
  • Fax: 770-532-2683
Mailing address:
  • Phone: 770-532-7246
  • Fax: 770-532-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JODY L WHISENANT
Title or Position: SECRETARY-TREASURER
Credential: O.D.
Phone: 770-532-7246