Healthcare Provider Details

I. General information

NPI: 1013471721
Provider Name (Legal Business Name): VISION EYE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2019
Last Update Date: 12/16/2023
Certification Date: 12/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 RIVERSIDE DR
MACON GA
31210-1805
US

IV. Provider business mailing address

4050 RIVERSIDE DR
MACON GA
31210-1805
US

V. Phone/Fax

Practice location:
  • Phone: 478-744-1710
  • Fax:
Mailing address:
  • Phone: 812-243-7468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID WESLEY BOONE
Title or Position: MANAGING DIRECTOR
Credential: DO
Phone: 812-243-7468