Provider Demographics
NPI:1508185729
Name:GS EYECARE INC
Entity Type:Organization
Organization Name:GS EYECARE INC
Other - Org Name:EYE SITE OF CLEVELAND FAMILY VISION
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:K
Authorized Official - Last Name:GABRELS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-219-3300
Mailing Address - Street 1:897 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-1458
Mailing Address - Country:US
Mailing Address - Phone:770-219-3300
Mailing Address - Fax:770-219-3300
Practice Address - Street 1:897 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-1458
Practice Address - Country:US
Practice Address - Phone:770-219-3300
Practice Address - Fax:770-219-3300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GS EYECARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAL20063005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA101533Medicaid
GA000873232AMedicaid
GA000873232AMedicaid
GA41ZCDRJMedicare PIN