Provider Demographics
NPI:1679005847
Name:OAKWOOD EYE ASSOCIATES
Entity Type:Organization
Organization Name:OAKWOOD EYE ASSOCIATES
Other - Org Name:ELAN EYE OF OAKWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-965-5101
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-0007
Mailing Address - Country:US
Mailing Address - Phone:770-965-5101
Mailing Address - Fax:770-965-5102
Practice Address - Street 1:4008 MUNDY MILL RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2807
Practice Address - Country:US
Practice Address - Phone:770-534-5305
Practice Address - Fax:770-534-5191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002307152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty