Provider Demographics
NPI:1790806024
Name:Z&B OPTICAL
Entity Type:Organization
Organization Name:Z&B OPTICAL
Other - Org Name:WILKES EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:706-678-4421
Mailing Address - Street 1:23 EAST SQ
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30673-1517
Mailing Address - Country:US
Mailing Address - Phone:706-678-4421
Mailing Address - Fax:706-678-3933
Practice Address - Street 1:23 EAST SQ
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:GA
Practice Address - Zip Code:30673-1517
Practice Address - Country:US
Practice Address - Phone:706-678-4421
Practice Address - Fax:706-678-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO001302156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1114100001Medicare ID - Type Unspecified