Provider Demographics
NPI:1699830091
Name:EYE 1ST HOLDINGS LLC
Entity Type:Organization
Organization Name:EYE 1ST HOLDINGS LLC
Other - Org Name:EYE 1ST VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHIDA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-252-1702
Mailing Address - Street 1:901 ABERNATHY RD.
Mailing Address - Street 2:STE 100
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:404-252-1702
Mailing Address - Fax:404-303-8843
Practice Address - Street 1:901 ABERNATHY RD STE 100
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-2561
Practice Address - Country:US
Practice Address - Phone:404-252-1702
Practice Address - Fax:404-303-8843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA917152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA823239700AMedicaid
GA41ZCDQDMedicare ID - Type Unspecified
GA823239700AMedicaid