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General NPI Number Information
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NPI Number | 1568528537
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Entity Type | Organization
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Legal Business Name | EYE DOCTORS CENTER, P.C.
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 05/27/2013
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Provider Practice Location Address
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Address Line | 210 S 16TH ST
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City | GRIFFIN
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State | GA
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Zip | 30224-2663
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Country | US
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Telephone | 770-229-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 210 S 16TH ST
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City | GRIFFIN
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State | GA
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Zip | 30224-2663
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Country | US
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Telephone | 770-229-8700
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JAMES JEFFREY CLARK
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Credential | O.D
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Telephone | 770-229-8700
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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 | 1184
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License Number State | GA
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