Healthcare Provider Details

I. General information

NPI: 1194481606
Provider Name (Legal Business Name): THOMAS EYE GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1544 SOUTHLAKE PKWY STE 9B
MORROW GA
30260-3025
US

IV. Provider business mailing address

5901 PEACHTREE DUNWOODY RD STE A500
ATLANTA GA
30328-7162
US

V. Phone/Fax

Practice location:
  • Phone: 770-961-9090
  • Fax: 770-961-4343
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL L KAUFMAN
Title or Position: DIRECTOR
Credential:
Phone: 678-892-2020