Provider Demographics
NPI:1619090354
Name:NORTH MACON EYECARE
Entity Type:Organization
Organization Name:NORTH MACON EYECARE
Other - Org Name:BROWN'S EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:S
Authorized Official - Middle Name:GREGG
Authorized Official - Last Name:FITZGIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:478-757-7600
Mailing Address - Street 1:4445 FORSYTH RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4525
Mailing Address - Country:US
Mailing Address - Phone:478-757-8600
Mailing Address - Fax:
Practice Address - Street 1:4445 FORSYTH RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4525
Practice Address - Country:US
Practice Address - Phone:478-757-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1816156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty