=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831393669
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNTAIN EYE CARE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2007
-----------------------------------------------------
Last Update Date | 10/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 253 HIGHWAY 515 E BLDG C
-----------------------------------------------------
City | BLAIRSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30512-3697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-745-3900
-----------------------------------------------------
Fax | 706-745-2705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 253 HIGHWAY 515 E BLDG C
-----------------------------------------------------
City | BLAIRSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30512-3697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-745-3900
-----------------------------------------------------
Fax | 706-745-2705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN-MARK TURNER
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 706-745-3900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | GA1355
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------