Provider Demographics
NPI:1578079869
Name:PROFESSIONAL EYE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL EYE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CURD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:706-226-2020
Mailing Address - Street 1:1111 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720
Mailing Address - Country:US
Mailing Address - Phone:706-226-2020
Mailing Address - Fax:706-529-3322
Practice Address - Street 1:113 WEST PINE STREET
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705
Practice Address - Country:US
Practice Address - Phone:706-226-2020
Practice Address - Fax:706-529-3322
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROFESSIONAL EYE ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier