=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285617647
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAINESVILLE EYE ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2005
-----------------------------------------------------
Last Update Date | 11/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2061 BEVERLY RD
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30501-2034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-532-4444
-----------------------------------------------------
Fax | 770-535-1852
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2061 BEVERLY RD
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30501-2034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-532-4444
-----------------------------------------------------
Fax | 770-535-1852
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | DR. STEPHEN J FARKAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 770-532-4444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------