Provider Demographics
NPI:1205044823
Name:EYE SITE OF GAINESVILLE, INC.
Entity Type:Organization
Organization Name:EYE SITE OF GAINESVILLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:K
Authorized Official - Last Name:GABRELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-532-0532
Mailing Address - Street 1:1681 THOMPSON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-1715
Mailing Address - Country:US
Mailing Address - Phone:770-532-0532
Mailing Address - Fax:770-532-0393
Practice Address - Street 1:1681 THOMPSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-1715
Practice Address - Country:US
Practice Address - Phone:770-532-0532
Practice Address - Fax:770-532-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2139087-BW152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty