MEDICARE: AUGUSTA EYE MD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier
2	156FX1800X	Optician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0657850001	OTHER	SC	GROUP DMERC NUMBER

General Provider Information

NPI Number	:	1225086721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUGUSTA EYE MD, PC

Provider Business Mailing Address
First Line	:	905 STEVENS CREEK RD STE A
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30907-3201
Country	:	US
Telephone Number	:	706-922-6000
Fax Number	:	706-722-7994

Provider Business Practice Location Address
First Line	:	905 STEVENS CREEK RD STE A
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30907-3201
Country	:	US
Telephone Number	:	706-922-6000
Fax Number	:	706-722-7994

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	STUART D. MARKS
Credential	:	MD
Telephone Number	:	706-922-6000

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/15/2022

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Directions to “AUGUSTA EYE MD, PC ” Practice Location

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