Provider Demographics
NPI:1467735829
Name:QUALITY EYECARE
Entity Type:Organization
Organization Name:QUALITY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:678-847-5331
Mailing Address - Street 1:5900 SUGARLOAF PKWY
Mailing Address - Street 2:SUITE 513
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7857
Mailing Address - Country:US
Mailing Address - Phone:678-847-5331
Mailing Address - Fax:678-847-5333
Practice Address - Street 1:5900 SUGARLOAF PKWY
Practice Address - Street 2:SUITE 513
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7857
Practice Address - Country:US
Practice Address - Phone:678-847-5331
Practice Address - Fax:678-847-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001445152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129516AMedicaid
202G415003Medicare PIN