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General NPI Number Information
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NPI Number | 1154634400
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Entity Type | Organization
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Legal Business Name | ST SIMONS EYE CARE, LLC
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 03/07/2014
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Provider Practice Location Address
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Address Line | 110 ISLAND PROFESSIONAL PARK
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City | ST. SIMONS ISLAND
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State | GA
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Zip | 31522-2880
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Country | US
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Telephone | 912-634-3444
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Fax |
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Provider Business Mailing Address
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Address Line | 110 ISLAND PROFESSIONAL PARK
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City | ST. SIMONS ISLAND
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State | GA
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Zip | 31522-2880
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SARA PHELPS
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Credential | O.D.
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Telephone | 912-230-6468
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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 | 2311
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License Number State | GA
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