Provider Demographics
NPI:1659636694
Name:THOMAS EYE GROUP PC
Entity Type:Organization
Organization Name:THOMAS EYE GROUP PC
Other - Org Name:THOMAS EYE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BONNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-781-7373
Mailing Address - Street 1:5901A PEACHTREE DUNWOODY RD
Mailing Address - Street 2:STE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:678-781-7373
Mailing Address - Fax:
Practice Address - Street 1:1120 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:STE 101
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2013
Practice Address - Country:US
Practice Address - Phone:678-892-2020
Practice Address - Fax:678-538-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty