Provider Demographics
NPI:1922170117
Name:PRCHAL AND PRCHAL, P.C.
Entity Type:Organization
Organization Name:PRCHAL AND PRCHAL, P.C.
Other - Org Name:BLAKELY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:PRCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-723-3644
Mailing Address - Street 1:6 COURT SQ
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:GA
Mailing Address - Zip Code:39823-2637
Mailing Address - Country:US
Mailing Address - Phone:229-723-3644
Mailing Address - Fax:229-723-3054
Practice Address - Street 1:6 COURT SQ
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:GA
Practice Address - Zip Code:39823-2637
Practice Address - Country:US
Practice Address - Phone:229-723-3644
Practice Address - Fax:229-723-3054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA890152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1770691693OtherINDIVIDUAL NPI
GA41ZCBDXMedicare ID - Type Unspecified
GAT89057Medicare UPIN