Provider Demographics
NPI:1205155116
Name:EECARMAN OD PC
Entity type:Organization
Organization Name:EECARMAN OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:E
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-499-2020
Mailing Address - Street 1:1615 RIDENOUR BLVD NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4463
Mailing Address - Country:US
Mailing Address - Phone:770-499-2020
Mailing Address - Fax:770-426-8157
Practice Address - Street 1:1615 RIDENOUR BLVD NW
Practice Address - Street 2:SUITE 201
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4463
Practice Address - Country:US
Practice Address - Phone:770-499-2020
Practice Address - Fax:770-426-8157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU22223Medicare UPIN
GA202G418279Medicare PIN