Provider Demographics
NPI:1528032034
Name:EYE DESIGNS OPTICAL
Entity Type:Organization
Organization Name:EYE DESIGNS OPTICAL
Other - Org Name:EYE DESIGNS OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:N
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-743-1342
Mailing Address - Street 1:1429 OGLETHORPE ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1512
Mailing Address - Country:US
Mailing Address - Phone:478-743-1342
Mailing Address - Fax:478-743-6296
Practice Address - Street 1:1429 OGLETHORPE ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1512
Practice Address - Country:US
Practice Address - Phone:478-743-1342
Practice Address - Fax:478-743-6296
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CENTER OF CENTRAL GEORGIA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-14
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1148360001Medicare NSC