Provider Demographics
NPI:1578768859
Name:GEORGIA EYE PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:GEORGIA EYE PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-804-1684
Mailing Address - Street 1:1970 RIVERSIDE PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5937
Mailing Address - Country:US
Mailing Address - Phone:770-804-1684
Mailing Address - Fax:770-804-1679
Practice Address - Street 1:3425 LENOX RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1308
Practice Address - Country:US
Practice Address - Phone:770-804-1684
Practice Address - Fax:770-804-1679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherEIN