Provider Demographics
NPI:1942365424
Name:JAMES H TRESTON
Entity Type:Organization
Organization Name:JAMES H TRESTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:TRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:386-416-9005
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:GA
Mailing Address - Zip Code:31302-0273
Mailing Address - Country:US
Mailing Address - Phone:386-416-9005
Mailing Address - Fax:
Practice Address - Street 1:160 POOLER PKWY
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4200
Practice Address - Country:US
Practice Address - Phone:912-748-9597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPT002342152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty