Provider Demographics
NPI:1598905861
Name:TIFT EYE CARE
Entity Type:Organization
Organization Name:TIFT EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:229-382-4441
Mailing Address - Street 1:363 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4813
Mailing Address - Country:US
Mailing Address - Phone:229-382-4441
Mailing Address - Fax:229-386-0211
Practice Address - Street 1:363 MAIN ST S
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4813
Practice Address - Country:US
Practice Address - Phone:229-382-4441
Practice Address - Fax:229-386-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA479332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1053594358Medicare NSC