Provider Demographics
NPI:1083944771
Name:CHANDLER MORGAN EYEWORKS,LLC
Entity Type:Organization
Organization Name:CHANDLER MORGAN EYEWORKS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:CHANDLER-MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:229-591-0024
Mailing Address - Street 1:PO BOX 1225
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-1225
Mailing Address - Country:US
Mailing Address - Phone:229-924-9998
Mailing Address - Fax:229-924-9991
Practice Address - Street 1:208 E LAMAR ST
Practice Address - Street 2:SUITE B
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3694
Practice Address - Country:US
Practice Address - Phone:229-924-9998
Practice Address - Fax:229-924-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-03
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2315305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization