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General NPI Number Information
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NPI Number | 1073772828
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Entity Type | Organization
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Legal Business Name | MOUNTAIN EYE CLINIC, PC
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 431 GROVE ST N SUITE C
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City | DAHLONEGA
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State | GA
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Zip | 30533-0437
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Country | US
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Telephone | 706-864-8635
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Fax | 706-864-2441
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Provider Business Mailing Address
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Address Line | 431 GROVE ST N SUITE C
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City | DAHLONEGA
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State | GA
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Zip | 30533-0437
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Country | US
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Telephone | 706-864-8635
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Fax | 706-864-2441
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | MR. RICHARD G JABALEY
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Credential | O.D.
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Telephone | 706-864-8635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT001389
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License Number State | GA
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