Provider Demographics
NPI:1225086721
Name:AUGUSTA EYE MD, PC
Entity Type:Organization
Organization Name:AUGUSTA EYE MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-922-6000
Mailing Address - Street 1:905 STEVENS CREEK RD STE A
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3201
Mailing Address - Country:US
Mailing Address - Phone:706-922-6000
Mailing Address - Fax:706-722-7994
Practice Address - Street 1:905 STEVENS CREEK RD STE A
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-3201
Practice Address - Country:US
Practice Address - Phone:706-922-6000
Practice Address - Fax:706-722-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGPA573Medicaid
SC0657850001OtherGROUP DMERC NUMBER
SC0657850001OtherGROUP DMERC NUMBER