Provider Demographics
NPI:1629260492
Name:AGAPE EYE CARE AND LASER CENTER
Entity Type:Organization
Organization Name:AGAPE EYE CARE AND LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:JENT
Authorized Official - Last Name:PASCHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-299-5798
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-0847
Mailing Address - Country:US
Mailing Address - Phone:706-299-5798
Mailing Address - Fax:706-299-5799
Practice Address - Street 1:744 NOAH DR
Practice Address - Street 2:SUITE 108
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-8705
Practice Address - Country:US
Practice Address - Phone:706-299-5798
Practice Address - Fax:706-299-5799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVTMP-02323207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty