Provider Demographics
NPI:1306029251
Name:ROSE EYE CARE, INC.
Entity Type:Organization
Organization Name:ROSE EYE CARE, INC.
Other - Org Name:EASON EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:EASON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:229-227-9200
Mailing Address - Street 1:14815 HWY. 19 SOUTH
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4889
Mailing Address - Country:US
Mailing Address - Phone:229-227-9200
Mailing Address - Fax:229-226-6057
Practice Address - Street 1:14815 US HIGHWAY 19 S
Practice Address - Street 2:SUITE 1000
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4889
Practice Address - Country:US
Practice Address - Phone:229-227-9200
Practice Address - Fax:229-226-6057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001177332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000477815BMedicaid
GA52295473OtherBCBS GEORGIA
GAU28358Medicare UPIN
GA000477815BMedicaid
GA5933060001Medicare NSC