Provider Demographics
NPI:1558530675
Name:AMERICAN EYECARE CENTER WAYCROSS PC
Entity Type:Organization
Organization Name:AMERICAN EYECARE CENTER WAYCROSS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:912-283-9383
Mailing Address - Street 1:1730 BRUNSWICK HWY
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-0908
Mailing Address - Country:US
Mailing Address - Phone:912-283-9383
Mailing Address - Fax:912-285-9333
Practice Address - Street 1:1730 BRUNSWICK HWY
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-0908
Practice Address - Country:US
Practice Address - Phone:912-283-9383
Practice Address - Fax:912-285-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA980T261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00268133BMedicaid
GAT93305Medicare UPIN
GA0289410001Medicare NSC
GA00268133BMedicaid