Provider Demographics
NPI:1225173578
Name:LOW COUNTRY EYE ASSOCIATES, PC
Entity Type:Organization
Organization Name:LOW COUNTRY EYE ASSOCIATES, PC
Other - Org Name:LOW COUNTRY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:912-748-1272
Mailing Address - Street 1:1000 TOWNE CENTER BLVD STE 502
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4068
Mailing Address - Country:US
Mailing Address - Phone:912-748-1272
Mailing Address - Fax:912-748-1996
Practice Address - Street 1:1000 TOWNE CENTER BLVD STE 502
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4068
Practice Address - Country:US
Practice Address - Phone:912-748-1272
Practice Address - Fax:912-748-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty