Provider Demographics
NPI:1003547803
Name:EYE CONSULTANTS: FAYETTEVILLE SURGERY CENTER
Entity Type:Organization
Organization Name:EYE CONSULTANTS: FAYETTEVILLE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGREW
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-429-8855
Mailing Address - Street 1:350 BRANDYWINE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1562
Mailing Address - Country:US
Mailing Address - Phone:678-801-6818
Mailing Address - Fax:
Practice Address - Street 1:350 BRANDYWINE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1562
Practice Address - Country:US
Practice Address - Phone:678-801-6818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty