Provider Demographics
NPI:1033321369
Name:CALDWELL & SON OPTICIANS INC
Entity Type:Organization
Organization Name:CALDWELL & SON OPTICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:478-743-2020
Mailing Address - Street 1:684 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2851
Mailing Address - Country:US
Mailing Address - Phone:478-743-2020
Mailing Address - Fax:478-743-0985
Practice Address - Street 1:684 1ST ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2851
Practice Address - Country:US
Practice Address - Phone:478-743-2020
Practice Address - Fax:478-743-0985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO001859156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty