Provider Demographics
NPI:1063683381
Name:THOMAS EYE CENTER
Entity Type:Organization
Organization Name:THOMAS EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-549-7757
Mailing Address - Street 1:1077 BAXTER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3767
Mailing Address - Country:US
Mailing Address - Phone:706-549-7757
Mailing Address - Fax:706-549-4186
Practice Address - Street 1:1077 BAXTER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-3767
Practice Address - Country:US
Practice Address - Phone:706-549-7757
Practice Address - Fax:706-549-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1062152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAT97872Medicare UPIN
GA511G700295Medicare PIN
GA0373580001Medicare NSC