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General NPI Number Information
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NPI Number | 1508419714
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Entity Type | Individual
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Provider Name | TAYLOR FICEK OD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 1725 ELECTRIC AVE STE 100A
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City | WATKINSVILLE
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State | GA
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Zip | 30677-2608
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Country | US
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Telephone | 706-237-9128
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Fax | 706-237-9129
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Provider Business Mailing Address
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Address Line | 129 COLHAM FERRY RD
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City | WATKINSVILLE
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State | GA
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Zip | 30677-2619
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Country | US
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Telephone | 402-525-2056
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPT003161
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License Number State | GA
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