Provider Demographics
NPI:1437523826
Name:THOMASVILLE EYE CARE, LLC
Entity Type:Organization
Organization Name:THOMASVILLE EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:229-227-1940
Mailing Address - Street 1:PO BOX 6370
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31758-6370
Mailing Address - Country:US
Mailing Address - Phone:229-227-1940
Mailing Address - Fax:229-227-5629
Practice Address - Street 1:15328 US HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-4824
Practice Address - Country:US
Practice Address - Phone:229-227-1940
Practice Address - Fax:229-227-5629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA 1210152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty