Provider Demographics
NPI:1356466114
Name:EVANS EYE CARE
Entity Type:Organization
Organization Name:EVANS EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-863-1800
Mailing Address - Street 1:4091 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:APPLING
Mailing Address - State:GA
Mailing Address - Zip Code:30802-4021
Mailing Address - Country:US
Mailing Address - Phone:706-863-1800
Mailing Address - Fax:
Practice Address - Street 1:3450 WRIGHTSBORO RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2516
Practice Address - Country:US
Practice Address - Phone:706-863-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001138152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T97659Medicare UPIN