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General NPI Number Information
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NPI Number | 1568792067
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Entity Type | Organization
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Legal Business Name | VISION SAVERS
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Dates
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Enumeration Date | 01/05/2010
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Last Update Date | 01/05/2010
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Provider Practice Location Address
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Address Line | 3661 EISENHOWER PKWY SUITE 55
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City | MACON
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State | GA
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Zip | 31206-3649
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Country | US
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Telephone | 478-475-4555
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Fax | 478-475-1370
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Provider Business Mailing Address
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Address Line | 3661 EISENHOWER PKWY SUITE 55
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City | MACON
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State | GA
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Zip | 31206-3649
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Country | US
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Telephone | 478-475-4555
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Fax | 478-475-1370
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Authorized Official
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Title or Position | OWNER/ DR.
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Name | DR. NORMAN LYLE LASTINGER
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Credential | O.D.
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Telephone | 478-475-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | OPT001094
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License Number State | GA
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