Provider Demographics
NPI:1508900879
Name:PICKENS EYE CLINIC
Entity Type:Organization
Organization Name:PICKENS EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-692-2878
Mailing Address - Street 1:360 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1400
Mailing Address - Country:US
Mailing Address - Phone:706-692-2878
Mailing Address - Fax:706-692-2879
Practice Address - Street 1:360 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1400
Practice Address - Country:US
Practice Address - Phone:706-692-2878
Practice Address - Fax:706-692-2879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty