Provider Demographics
NPI:1710952890
Name:APPLING EYE CLINIC,INC.
Entity Type:Organization
Organization Name:APPLING EYE CLINIC,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:FORTH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:912-367-7754
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31515-0070
Mailing Address - Country:US
Mailing Address - Phone:912-367-7754
Mailing Address - Fax:912-367-0775
Practice Address - Street 1:77 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0567
Practice Address - Country:US
Practice Address - Phone:912-367-7754
Practice Address - Fax:912-367-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000842152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAT97581Medicare UPIN
GA41ZCDNBMedicare ID - Type Unspecified