Healthcare Provider Details

I. General information

NPI: 1922118397
Provider Name (Legal Business Name): THOMAS EYE GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 LAWRENCEVILLE HWY NW
LILBURN GA
30047-2817
US

IV. Provider business mailing address

5901A PEACHTREE DUNWOODY RD NE STE 500
ATLANTA GA
30328-5382
US

V. Phone/Fax

Practice location:
  • Phone: 770-717-1191
  • Fax: 770-717-9325
Mailing address:
  • Phone: 678-892-2020
  • Fax: 678-538-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ROD ROESER
Title or Position: CEO
Credential:
Phone: 678-781-7373