Provider Demographics
NPI:1467672832
Name:GEORGIA EYE CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:GEORGIA EYE CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZLEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-538-8182
Mailing Address - Street 1:PO BOX 1326
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-1326
Mailing Address - Country:US
Mailing Address - Phone:912-538-8182
Mailing Address - Fax:912-538-7551
Practice Address - Street 1:106 QUEEN STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474
Practice Address - Country:US
Practice Address - Phone:912-538-8182
Practice Address - Fax:912-538-7551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6483Medicare ID - Type UnspecifiedGRP