Provider Demographics
NPI:1013910918
Name:BOLAND EYE CENTER PC
Entity Type:Organization
Organization Name:BOLAND EYE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:U
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-352-2299
Mailing Address - Street 1:PO BOX 13827
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-3827
Mailing Address - Country:US
Mailing Address - Phone:912-352-2299
Mailing Address - Fax:912-352-0012
Practice Address - Street 1:1615 E MONTGOMERY CROSS RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-5056
Practice Address - Country:US
Practice Address - Phone:912-352-2299
Practice Address - Fax:912-352-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3079OtherMEDICARE-PART B
GACH2898Medicare PIN
GA1108070001Medicare NSC