Provider Demographics
NPI:1922254523
Name:EAGLE EYE AND MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:EAGLE EYE AND MEDICAL CLINIC INC
Other - Org Name:COVINGTON VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZIR
Authorized Official - Middle Name:AHMAD
Authorized Official - Last Name:KHAWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-784-1172
Mailing Address - Street 1:3138B HIGHWAY 278 NW
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2304
Mailing Address - Country:US
Mailing Address - Phone:770-784-1172
Mailing Address - Fax:770-788-8824
Practice Address - Street 1:3138B HIGHWAY 278 NW
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2304
Practice Address - Country:US
Practice Address - Phone:770-784-1172
Practice Address - Fax:770-788-8824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025778207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD29922Medicare UPIN