Provider Demographics
NPI:1245429539
Name:EYECARE PLUS INC
Entity Type:Organization
Organization Name:EYECARE PLUS INC
Other - Org Name:DAVID A. JOHNSON O.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-487-2020
Mailing Address - Street 1:301B PETROL PT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1552
Mailing Address - Country:US
Mailing Address - Phone:770-487-2020
Mailing Address - Fax:770-487-2020
Practice Address - Street 1:301B PETROL PT
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1552
Practice Address - Country:US
Practice Address - Phone:770-487-2020
Practice Address - Fax:770-487-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1105152WC0802X
GAGA1040152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6012Medicare PIN
GA0810130001Medicare NSC