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General NPI Number Information
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NPI Number | 1184901258
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Entity Type | Organization
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Legal Business Name | S & H EYE CARE, LLC
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Dates
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Enumeration Date | 11/03/2011
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 1120 15TH ST BA2660
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City | AUGUSTA
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State | GA
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Zip | 30912-0004
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Country | US
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Telephone | 706-826-0049
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Fax | 706-826-0050
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Provider Business Mailing Address
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Address Line | 1120 15TH ST BA2660
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City | AUGUSTA
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State | GA
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Zip | 30912-0004
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Country | US
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Telephone | 706-826-0049
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Fax | 706-826-0050
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Authorized Official
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Title or Position | MANAGER
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Name | TRACIE L SPONSELLER
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Credential | OD
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Telephone | 803-642-4339
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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 | OPT002160
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License Number State | GA
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