Healthcare Provider Details

I. General information

NPI: 1336432251
Provider Name (Legal Business Name): IDOC HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5377 HIGHWAY 136
TRENTON GA
30752-2900
US

IV. Provider business mailing address

PO BOX 156
TRENTON GA
30752-0156
US

V. Phone/Fax

Practice location:
  • Phone: 706-657-7559
  • Fax: 706-657-3937
Mailing address:
  • Phone: 706-657-7559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1300
License Number StateTN

VIII. Authorized Official

Name: OCECLIA FINNEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 706-657-7559