Provider Demographics
NPI:1033439252
Name:BLATT EYE CENTER, P.C.
Entity Type:Organization
Organization Name:BLATT EYE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-949-3885
Mailing Address - Street 1:PO BOX 2010
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30133-2010
Mailing Address - Country:US
Mailing Address - Phone:770-949-3885
Mailing Address - Fax:770-949-3882
Practice Address - Street 1:6001 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE 2000
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5602
Practice Address - Country:US
Practice Address - Phone:770-949-3885
Practice Address - Fax:770-949-3882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020964207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00190495AMedicaid
GA020964OtherGA LICENSE
GA00190495AMedicaid