Provider Demographics
NPI:1851571384
Name:EYE CARE OF WAYCROSS PC
Entity Type:Organization
Organization Name:EYE CARE OF WAYCROSS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ZECHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:912-285-2021
Mailing Address - Street 1:2215 MEMORIAL DR
Mailing Address - Street 2:SUITE 25
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-0983
Mailing Address - Country:US
Mailing Address - Phone:912-285-2021
Mailing Address - Fax:912-285-2558
Practice Address - Street 1:2215 MEMORIAL DR
Practice Address - Street 2:SUITE 25
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-0983
Practice Address - Country:US
Practice Address - Phone:912-285-2021
Practice Address - Fax:912-285-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0976T302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000348906AMedicaid
GA000348906AMedicaid
GA5705800001Medicare NSC