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General NPI Number Information
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NPI Number | 1578079869
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL EYE ASSOCIATES, INC.
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 12/21/2017
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Provider Practice Location Address
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Address Line | 113 WEST PINE STREET
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City | CHATSWORTH
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State | GA
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Zip | 30705
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Country | US
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Telephone | 706-226-2020
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Fax | 706-529-3322
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Provider Business Mailing Address
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Address Line | 1111 PROFESSIONAL BLVD
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City | DALTON
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State | GA
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Zip | 30720
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Country | US
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Telephone | 706-226-2020
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Fax | 706-529-3322
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | SANDRA D CURD
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Credential | MBA
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Telephone | 706-226-2020
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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 |
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License Number State | GA
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