Provider Demographics
NPI:1912203746
Name:FORTNEY EYE CARE, LLC
Entity Type:Organization
Organization Name:FORTNEY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-461-1133
Mailing Address - Street 1:PO BOX 2065
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-0052
Mailing Address - Country:US
Mailing Address - Phone:706-461-1133
Mailing Address - Fax:253-981-8053
Practice Address - Street 1:3886 GA HIGHWAY 17 RD
Practice Address - Street 2:
Practice Address - City:EASTANOLLEE
Practice Address - State:GA
Practice Address - Zip Code:30538-3808
Practice Address - Country:US
Practice Address - Phone:706-297-7292
Practice Address - Fax:706-297-7317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty