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NPI Code Detail

MEDICARE: EYE PHYSICIANS AND SURGEONS OF AUGUSTA, PC

MEDICARE: EYE PHYSICIANS AND SURGEONS OF AUGUSTA, 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
1152W00000XOptometrist
2332H00000XEyewear Supplier
3207W00000XOphthalmology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
140138OTHERGAAVESIS PIN
252748856OTHERBCBS OF GA-OPTICAL NUMBER

General Provider Information

NPI Number : 1386705069
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYE PHYSICIANS AND SURGEONS OF AUGUSTA, PC
Provider Business Mailing Address
First Line : 1330 INTERSTATE PKWY
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-5625
Country : US
Telephone Number : 706-651-2020
Fax Number : 706-651-2032
Provider Business Practice Location Address
First Line : 1330 INTERSTATE PKWY
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-5625
Country : US
Telephone Number : 706-651-2020
Fax Number : 706-651-2032
Authorized Official
Title or Position : PRESIDENT
Name : DR. BRADLEY ALAN BERTRAM
Credential : M.D.
Telephone Number : 706-651-2020
Provider Enumeration Date : 12/13/2006
Last Update Date : 08/12/2019

Similar Medicare Providers

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Practice Location Address:
1330 INTERSTATE PKWY
AUGUSTA, GA
30909-5625
Practice Phone: 706-651-2020
Practice Fax: 706-651-2032
1093798993 — DR. BEAU GARDNER M.D.
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Practice Fax: 706-855-6674
1063467454 — DR. HERBERT PETER FECHTER III MD
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AUGUSTA, GA
30909-5625
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Practice Fax: 706-855-6674
1184785008 — DR. BRADLEY ALAN BERTRAM M.D.
Practice Location Address:
1330 INTERSTATE PKWY
AUGUSTA, GA
30909-5625
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Practice Fax: 706-855-6674
1508927310 — DR. BRUCE ALLEN BROWN M.D.
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AUGUSTA, GA
30909-5625
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1003017468 — DR. RYAN THOMAS SMITH MD
Practice Location Address:
1330 INTERSTATE PKWY
AUGUSTA, GA
30909-5625
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Practice Fax: 706-855-6674

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