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General NPI Number Information
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NPI Number | 1487928701
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Entity Type | Organization
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Legal Business Name | FRANKLIN COUNTY EYE CARE
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 13375 JONES ST SUITE B-2
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City | LAVONIA
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State | GA
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Zip | 30553-1147
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Country | US
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Telephone | 706-356-0206
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Fax | 706-356-0346
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Provider Business Mailing Address
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Address Line | 13375 JONES ST SUITE B-2
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City | LAVONIA
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State | GA
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Zip | 30553-1147
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Country | US
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Telephone | 706-356-0206
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Fax | 706-356-0346
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN RICK VANDERHOEF
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Credential | O.D.
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Telephone | 706-356-0206
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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 | GA1577
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License Number State | GA
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