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General NPI Number Information
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NPI Number | 1508185729
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Entity Type | Organization
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Legal Business Name | GS EYECARE INC
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 05/27/2010
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Provider Practice Location Address
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Address Line | 897 S MAIN ST
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City | CLEVELAND
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State | GA
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Zip | 30528-1458
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Country | US
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Telephone | 770-219-3300
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Fax | 770-219-3300
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Provider Business Mailing Address
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Address Line | 897 S MAIN ST
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City | CLEVELAND
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State | GA
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Zip | 30528-1458
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Country | US
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Telephone | 770-219-3300
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Fax | 770-219-3300
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JASON K GABRELS
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Credential | OD
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Telephone | 706-219-3300
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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 | L20063005
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License Number State | GA
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