Provider Demographics
NPI:1376135715
Name:MIDDLE GEORGIA OPTOMETRY
Entity Type:Organization
Organization Name:MIDDLE GEORGIA OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WESSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-485-7955
Mailing Address - Street 1:225 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2448
Mailing Address - Country:US
Mailing Address - Phone:941-661-7931
Mailing Address - Fax:
Practice Address - Street 1:201 WALMART DR
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-6761
Practice Address - Country:US
Practice Address - Phone:706-485-7955
Practice Address - Fax:706-485-7934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty