Provider Demographics
NPI:1225002777
Name:EYE CENTER OF CENTRAL GEORGIA, P.C.
Entity Type:Organization
Organization Name:EYE CENTER OF CENTRAL GEORGIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:N
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-743-7061
Mailing Address - Street 1:1429 OGLETHORPE ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1512
Mailing Address - Country:US
Mailing Address - Phone:478-743-7061
Mailing Address - Fax:478-743-6296
Practice Address - Street 1:1429 OGLETHORPE ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1512
Practice Address - Country:US
Practice Address - Phone:478-743-7061
Practice Address - Fax:478-743-6296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55000065AMedicaid
GACC3213OtherRAILROAD MEDICARE
GACC3213OtherRAILROAD MEDICARE