Provider Demographics
NPI:1518177849
Name:OLDHAM'S OPTICIANS, INC.
Entity Type:Organization
Organization Name:OLDHAM'S OPTICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADDISON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-746-4866
Mailing Address - Street 1:518 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2700
Mailing Address - Country:US
Mailing Address - Phone:478-746-4866
Mailing Address - Fax:
Practice Address - Street 1:518 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2700
Practice Address - Country:US
Practice Address - Phone:478-746-4866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000695156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0661590001Medicare ID - Type Unspecified