Provider Demographics
NPI:1568657880
Name:FIVE POINTS OPTOMETRISTS, PC
Entity Type:Organization
Organization Name:FIVE POINTS OPTOMETRISTS, PC
Other - Org Name:FIVE POINTS EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ISREAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-543-2020
Mailing Address - Street 1:698 S MILLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1251
Mailing Address - Country:US
Mailing Address - Phone:706-543-2020
Mailing Address - Fax:706-549-6618
Practice Address - Street 1:698 S MILLEDGE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1251
Practice Address - Country:US
Practice Address - Phone:706-543-2020
Practice Address - Fax:706-549-6618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300030774AMedicaid
GAGRP3442OtherMEDICARE GROUP