Provider Demographics
NPI:1790258374
Name:POPHAM EYECARE LLC
Entity Type:Organization
Organization Name:POPHAM EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:POPHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-748-2443
Mailing Address - Street 1:206 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-3040
Mailing Address - Country:US
Mailing Address - Phone:770-748-2443
Mailing Address - Fax:770-748-8885
Practice Address - Street 1:206 MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-3040
Practice Address - Country:US
Practice Address - Phone:770-748-2443
Practice Address - Fax:770-748-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1285127779OtherNPI