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General NPI Number Information
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NPI Number | 1629165642
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Entity Type | Organization
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Legal Business Name | GEORGIA EYE ASSOCIATES, P.C.
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 771 OLD NORCROSS RD SUITE 150
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4979
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Country | US
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Telephone | 770-995-5408
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Fax | 770-513-2042
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Provider Business Mailing Address
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Address Line | 771 OLD NORCROSS RD SUITE 150
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4979
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Country | US
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Telephone | 770-995-5408
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Fax | 770-513-2042
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Authorized Official
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Title or Position | OWNER
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Name | DR. DONALD E POLAND
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Credential | M.D.
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Telephone | 770-995-5408
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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 | OPT002167
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 050167
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 021751
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT001207
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT001163
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 031101
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License Number State | GA
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