Healthcare Provider Details

I. General information

NPI: 1962576165
Provider Name (Legal Business Name): MORRIS OPTICIANS AND HEARING AID CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3839 WASHINGTON ROAD
MARTINEZ GA
30907-5178
US

IV. Provider business mailing address

3839 WASHINGTON ROAD
MARTINEZ GA
30907-5178
US

V. Phone/Fax

Practice location:
  • Phone: 706-860-9800
  • Fax: 706-860-9209
Mailing address:
  • Phone: 706-860-9800
  • Fax: 706-860-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number643
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MILDRED T TISDALE
Title or Position: INS CLAIMS ADMIN
Credential: D.O
Phone: 803-564-5340