Provider Demographics
NPI:1124384607
Name:CLEAR SIGHT FAMILY EYECARE
Entity Type:Organization
Organization Name:CLEAR SIGHT FAMILY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:478-755-1295
Mailing Address - Street 1:1401 GRAY HWY
Mailing Address - Street 2:C/O WALMART OPTICAL
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1905
Mailing Address - Country:US
Mailing Address - Phone:478-755-1295
Mailing Address - Fax:
Practice Address - Street 1:1401 GRAY HWY
Practice Address - Street 2:C/O WALMART OPTICAL
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1905
Practice Address - Country:US
Practice Address - Phone:478-755-1295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2597152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I410811OtherMEDICARE