Provider Demographics
NPI:1477672780
Name:ROME EYE CARE
Entity Type:Organization
Organization Name:ROME EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:V
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-291-4642
Mailing Address - Street 1:1102 MARTHA BERRY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1612
Mailing Address - Country:US
Mailing Address - Phone:706-291-4642
Mailing Address - Fax:706-291-9644
Practice Address - Street 1:1102 MARTHA BERRY BLVD NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1612
Practice Address - Country:US
Practice Address - Phone:706-291-4642
Practice Address - Fax:706-291-9644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA 963332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU22544Medicare UPIN
GA41ZCCFFMedicare ID - Type UnspecifiedMEDICARE