Provider Demographics
NPI:1417298076
Name:GEORGIA EYECARE GROUP
Entity Type:Organization
Organization Name:GEORGIA EYECARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:GILES
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:478-278-4628
Mailing Address - Street 1:146 WILDWOOD PL
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-2796
Mailing Address - Country:US
Mailing Address - Phone:478-278-4628
Mailing Address - Fax:
Practice Address - Street 1:146 WILDWOOD PL
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-2796
Practice Address - Country:US
Practice Address - Phone:478-278-4628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001385152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty