Provider Demographics
NPI:1043349368
Name:TASMAN EYE CONSULTANTS PC
Entity Type:Organization
Organization Name:TASMAN EYE CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:R
Authorized Official - Last Name:TASMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-792-3937
Mailing Address - Street 1:1415 WOOTEN LAKE RD NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1336
Mailing Address - Country:US
Mailing Address - Phone:770-792-3937
Mailing Address - Fax:770-427-9826
Practice Address - Street 1:1415 WOOTEN LAKE RD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1336
Practice Address - Country:US
Practice Address - Phone:770-792-3937
Practice Address - Fax:770-427-9826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-04
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA0921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4645400001Medicare NSC
GAU22578Medicare UPIN
GAGRP4856Medicare ID - Type Unspecified
GAGRP4856Medicare PIN