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General NPI Number Information
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NPI Number | 1558530675
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Entity Type | Organization
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Legal Business Name | AMERICAN EYECARE CENTER WAYCROSS PC
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 1730 BRUNSWICK HWY
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City | WAYCROSS
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State | GA
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Zip | 31501-0908
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Country | US
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Telephone | 912-283-9383
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Fax | 912-285-9333
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Provider Business Mailing Address
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Address Line | 1730 BRUNSWICK HWY
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City | WAYCROSS
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State | GA
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Zip | 31501-0908
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Country | US
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Telephone | 912-283-9383
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Fax | 912-285-9333
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Authorized Official
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Title or Position | CEO
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Name | DR. RODNEY HOWARD BROWN
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Credential | O.D.
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Telephone | 912-283-9383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 980T
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License Number State | GA
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