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General NPI Number Information
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NPI Number | 1659520542
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Entity Type | Organization
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Legal Business Name | EYE CARE ASSOCIATES OF MIDDLE GA
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 1634 VETERANS BLVD STE C
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City | DUBLIN
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State | GA
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Zip | 31021-3500
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Country | US
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Telephone | 478-272-0249
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Fax |
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Provider Business Mailing Address
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Address Line | 198 S HOUSTON LAKE RD STE B
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City | WARNER ROBINS
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State | GA
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Zip | 31088-6473
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Country | US
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Telephone | 478-971-1500
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Fax | 478-971-2112
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Authorized Official
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Title or Position | OWNER
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Name | DUDLEY B CHRISTIE
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Credential | OD
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Telephone | 478-971-1500
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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 | OPT001236
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License Number State | GA
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