Provider Demographics
NPI:1467524090
Name:EASTMETRO EYECARE P.C.
Entity Type:Organization
Organization Name:EASTMETRO EYECARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-922-7906
Mailing Address - Street 1:1013 E FREEWAY DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5965
Mailing Address - Country:US
Mailing Address - Phone:770-922-7906
Mailing Address - Fax:770-483-0498
Practice Address - Street 1:1013 E FREEWAY DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5965
Practice Address - Country:US
Practice Address - Phone:770-922-7906
Practice Address - Fax:770-483-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA796152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAVGA001657OtherAVESIS
GAGA0796OtherEYEMED
GAT61170Medicare UPIN
GAGA0796OtherEYEMED
GAU72463Medicare UPIN