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General NPI Number Information
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NPI Number | 1427359959
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Entity Type | Organization
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Legal Business Name | COASTAL GEORGIA EYECARE, LLC
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 1 DIAMOND CSWY SUITE 21
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City | SAVANNAH
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State | GA
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Zip | 31406-7417
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Country | US
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Telephone | 912-655-5047
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Fax |
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Provider Business Mailing Address
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Address Line | 1 DIAMOND CSWY SUITE 21
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City | SAVANNAH
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State | GA
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Zip | 31406-7417
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Country | US
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Telephone | 912-655-5047
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. EDWARD D SAMMONS JR.
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Credential | O.D.
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Telephone | 912-655-5047
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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 | OPT2183
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License Number State | GA
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