Provider Demographics
NPI:1659520542
Name:EYE CARE ASSOCIATES OF MIDDLE GA
Entity Type:Organization
Organization Name:EYE CARE ASSOCIATES OF MIDDLE GA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:478-971-1500
Mailing Address - Street 1:198 S HOUSTON LAKE RD
Mailing Address - Street 2:STE B
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6473
Mailing Address - Country:US
Mailing Address - Phone:478-971-1500
Mailing Address - Fax:478-971-2112
Practice Address - Street 1:1634 VETERANS BLVD
Practice Address - Street 2:STE C
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3500
Practice Address - Country:US
Practice Address - Phone:478-272-0249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5673540002Medicare NSC