Provider Demographics
NPI:1235289448
Name:WARNER ROBINS PARTNERS
Entity Type:Organization
Organization Name:WARNER ROBINS PARTNERS
Other - Org Name:EYESIGHT'S LASER AND SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:478-922-5015
Mailing Address - Street 1:PO BOX 6908
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-6908
Mailing Address - Country:US
Mailing Address - Phone:478-922-5015
Mailing Address - Fax:478-922-5085
Practice Address - Street 1:220 CORDER ROAD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:478-922-5015
Practice Address - Fax:478-922-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA076208207W00000X, 261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA401002OtherBCBS
GA00893461AMedicaid
GA=========OtherUNITEDHEALTHCARE
GA=========OtherHUMANAGOLD
GA=========OtherSECUREHEALTH
GA=========OtherTAXIDENTIFICATION
GA=========OtherTRICARE
GA=========OtherTRICAREFORLIFE
GA=========OtherMAILHANDLERS
GA=========OtherKNIGHTSTEMPLAR
GA=========OtherAETNA
GA=========OtherUNITEDAMERICAN
GA00893461AMedicaid
GA=========OtherTRICAREFORLIFE