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General NPI Number Information
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NPI Number | 1548651920
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Entity Type | Organization
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Legal Business Name | TIFT EYE CARE, LLC
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Dates
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Enumeration Date | 02/06/2015
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 363 MAIN ST S
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City | TIFTON
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State | GA
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Zip | 31794-4813
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Country | US
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Telephone | 229-382-4441
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Fax | 229-386-0211
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Provider Business Mailing Address
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Address Line | 363 MAIN ST S
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City | TIFTON
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State | GA
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Zip | 31794-4813
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Country | US
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Telephone | 229-382-4441
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Fax | 229-386-0211
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Authorized Official
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Title or Position | MANAGER
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Name | ALTA M LEBECK
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Credential | LDO
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Telephone | 229-382-4441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | LDO002502
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License Number State | GA
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