Provider Demographics
NPI:1407992977
Name:DOWNTOWN OPTICIANS, INC
Entity Type:Organization
Organization Name:DOWNTOWN OPTICIANS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:478-405-5150
Mailing Address - Street 1:3933 BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-3615
Mailing Address - Country:US
Mailing Address - Phone:478-405-5150
Mailing Address - Fax:478-746-9865
Practice Address - Street 1:3933 BLOOMFIELD RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-3615
Practice Address - Country:US
Practice Address - Phone:478-405-5150
Practice Address - Fax:478-746-9865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO001314156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTIN