Provider Demographics
NPI:1023365236
Name:GOWDY VISION ASSOCIATES
Entity Type:Organization
Organization Name:GOWDY VISION ASSOCIATES
Other - Org Name:WEST END EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOWDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-429-2898
Mailing Address - Street 1:807 RALPH DAVID ABERNATHY BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1807
Mailing Address - Country:US
Mailing Address - Phone:404-755-4300
Mailing Address - Fax:404-755-8626
Practice Address - Street 1:807 RALPH DAVID ABERNATHY BLVD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1807
Practice Address - Country:US
Practice Address - Phone:404-755-4300
Practice Address - Fax:404-755-8626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1760152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G705615Medicare PIN