Provider Demographics
NPI:1588815575
Name:COOSA EYE CLINIC, INC
Entity Type:Organization
Organization Name:COOSA EYE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMETT
Authorized Official - Middle Name:PRICE
Authorized Official - Last Name:CORDLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-290-0098
Mailing Address - Street 1:2110 SHORTER AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2018
Mailing Address - Country:US
Mailing Address - Phone:706-290-0098
Mailing Address - Fax:706-290-0941
Practice Address - Street 1:2110 SHORTER AVE NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2018
Practice Address - Country:US
Practice Address - Phone:706-290-0098
Practice Address - Fax:706-290-0941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty