Provider Demographics
NPI:1154732824
Name:COWETA EYE ASSOCIATES, LLC
Entity type:Organization
Organization Name:COWETA EYE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:H
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-683-2733
Mailing Address - Street 1:15 RUTH DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2317
Mailing Address - Country:US
Mailing Address - Phone:770-683-2733
Mailing Address - Fax:
Practice Address - Street 1:15 RUTH DR
Practice Address - Street 2:SUITE C
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2317
Practice Address - Country:US
Practice Address - Phone:770-683-2733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002186152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV02236Medicare UPIN