Provider Demographics
NPI:1780859579
Name:MACON EYECARE ASSOCIATES INC
Entity Type:Organization
Organization Name:MACON EYECARE ASSOCIATES INC
Other - Org Name:MCDONOUGH FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOT
Authorized Official - Middle Name:M
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-898-7078
Mailing Address - Street 1:1385 HIGHWAY 20 W
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7304
Mailing Address - Country:US
Mailing Address - Phone:770-898-7078
Mailing Address - Fax:
Practice Address - Street 1:1385 HIGHWAY 20 W
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7304
Practice Address - Country:US
Practice Address - Phone:770-898-7078
Practice Address - Fax:770-898-7160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001919152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty