MEDICARE: THOMAS EYE GROUP 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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1649681420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS EYE GROUP PC

Provider Business Mailing Address
First Line	:	5901A PEACHTREE DUNWOODY RD STE 500
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5341
Country	:	US
Telephone Number	:	678-781-7373
Fax Number	:	678-538-1972

Provider Business Practice Location Address
First Line	:	4280 E WEST CONNECTOR SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-4804
Country	:	US
Telephone Number	:	770-435-4457
Fax Number	:	404-256-1981

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	SUSAN BONNETT
Credential	:
Telephone Number	:	678-781-7373

Provider Enumeration Date	:	05/14/2014
Last Update Date	:	06/17/2014

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