Provider Demographics
NPI:1760668545
Name:AUGUSTA EYE ASSOCIATES PLC
Entity Type:Organization
Organization Name:AUGUSTA EYE ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT SERVICES COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OCS
Authorized Official - Phone:540-213-7725
Mailing Address - Street 1:17 N MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2344
Mailing Address - Country:US
Mailing Address - Phone:540-213-7725
Mailing Address - Fax:540-213-7481
Practice Address - Street 1:1500 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-9032
Practice Address - Country:US
Practice Address - Phone:540-213-0060
Practice Address - Fax:540-213-9441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032138332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1002070002Medicare NSC