Provider Demographics
NPI:1700193828
Name:THE EYE GALLERY 20 20 INC
Entity Type:Organization
Organization Name:THE EYE GALLERY 20 20 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-263-7392
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:MINERAL BLUFF
Mailing Address - State:GA
Mailing Address - Zip Code:30559-0777
Mailing Address - Country:US
Mailing Address - Phone:706-263-7392
Mailing Address - Fax:
Practice Address - Street 1:165 OUTLET CENTER DRIVE
Practice Address - Street 2:SUITE 4
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-3733
Practice Address - Country:US
Practice Address - Phone:706-263-7392
Practice Address - Fax:706-263-7392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty