Provider Demographics
NPI:1821589441
Name:THOMAS EYE GROUP PC
Entity Type:Organization
Organization Name:THOMAS EYE GROUP PC
Other - Org Name:THOMAS EYE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-892-2020
Mailing Address - Street 1:5901 PEACHTREE DUNWOODY RD STE A500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-7162
Mailing Address - Country:US
Mailing Address - Phone:678-892-2020
Mailing Address - Fax:678-538-1950
Practice Address - Street 1:1110 W PEACHTREE ST NW STE 860
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3609
Practice Address - Country:US
Practice Address - Phone:678-892-2020
Practice Address - Fax:678-538-1950
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS EYE GROUP PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty