Provider Demographics
NPI:1346880903
Name:WOODSTOCK EYESITE INC
Entity Type:Organization
Organization Name:WOODSTOCK EYESITE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:E
Authorized Official - Last Name:NADEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-479-0123
Mailing Address - Street 1:1455 RIVERSTONE PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5627
Mailing Address - Country:US
Mailing Address - Phone:770-479-0123
Mailing Address - Fax:770-720-0104
Practice Address - Street 1:2360 TOWNE LAKE PKWY STE 104
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5576
Practice Address - Country:US
Practice Address - Phone:770-479-0123
Practice Address - Fax:770-720-0104
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEARLE VISION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty