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General NPI Number Information
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NPI Number | 1336432251
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Entity Type | Organization
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Legal Business Name | IDOC HOLDINGS LLC
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 5377 HIGHWAY 136
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City | TRENTON
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State | GA
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Zip | 30752-2900
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Country | US
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Telephone | 706-657-7559
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Fax | 706-657-3937
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Provider Business Mailing Address
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Address Line | PO BOX 156
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City | TRENTON
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State | GA
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Zip | 30752-0156
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Country | US
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Telephone | 706-657-7559
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | OCECLIA FINNEY
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Credential |
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Telephone | 706-657-7559
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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 | 1300
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License Number State | TN
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