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General NPI Number Information
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NPI Number | 1356466114
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Entity Type | Organization
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Legal Business Name | EVANS EYE CARE
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3450 WRIGHTSBORO RD
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City | AUGUSTA
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State | GA
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Zip | 30909-2516
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Country | US
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Telephone | 706-863-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 4091 PINE RIDGE RD
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City | APPLING
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State | GA
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Zip | 30802-4021
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Country | US
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Telephone | 706-863-1800
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. HAROLD J HOOVER
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Credential | OD
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Telephone | 706-863-1800
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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 | 001138
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License Number State | GA
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