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NPI Code Detail

MEDICARE: THOMASVILLE EYE CARE PC

MEDICARE: THOMASVILLE EYE CARE 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
1152W00000XOptometristGA1210GA

General Provider Information

NPI Number : 1962557843
Entity Type Code : Organization
Provider Name (Legal Business Name) : THOMASVILLE EYE CARE PC
Provider Business Mailing Address
First Line : 108 NORTHFIELD DR
Second Line :
City : THOMASVILLE
State : GA
Zip : 31757-9505
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15328 US HIGHWAY 19 S
Second Line :
City : THOMASVILLE
State : GA
Zip : 31757-4824
Country : US
Telephone Number : 229-227-1940
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DIANA MAURER
Credential :
Telephone Number : 229-227-1940
Provider Enumeration Date : 01/24/2007
Last Update Date : 08/22/2020

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Directions to “THOMASVILLE EYE CARE PC ” Practice Location

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