Healthcare Provider Details

I. General information

NPI: 1467459057
Provider Name (Legal Business Name): DAVID SASSOUNI EGHIGIAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1891 HWY 40 E STE 1102
KINGSLAND GA
31548-6573
US

IV. Provider business mailing address

3303A GLYNN AVE
BRUNSWICK GA
31520-4406
US

V. Phone/Fax

Practice location:
  • Phone: 912-576-4466
  • Fax: 912-576-4472
Mailing address:
  • Phone: 912-466-9500
  • Fax: 912-466-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003478
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: