Provider Demographics
NPI:1508042375
Name:ALL EYES VISION CARE, PC
Entity Type:Organization
Organization Name:ALL EYES VISION CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:CHASTEEN
Authorized Official - Last Name:SOSEBEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-932-9221
Mailing Address - Street 1:4965 LANIER ISLANDS PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1700
Mailing Address - Country:US
Mailing Address - Phone:770-932-9221
Mailing Address - Fax:
Practice Address - Street 1:4965 LANIER ISLANDS PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-1700
Practice Address - Country:US
Practice Address - Phone:770-932-9221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1851152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4859Medicare PIN