Provider Demographics
NPI:1295721082
Name:1 HOUR OPTICAL P C
Entity type:Organization
Organization Name:1 HOUR OPTICAL P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CROOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-860-1171
Mailing Address - Street 1:217 BOBBY JONES EXPY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-5255
Mailing Address - Country:US
Mailing Address - Phone:706-860-1171
Mailing Address - Fax:706-860-1841
Practice Address - Street 1:217 BOBBY JONES EXPY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-5255
Practice Address - Country:US
Practice Address - Phone:706-860-1171
Practice Address - Fax:706-860-1841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA717152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDPG717Medicaid
5132270001OtherDMERC
GA52540781004OtherBCBS
SCDAG983Medicaid
GA5055266711OtherTRICARE
GAGA0717OtherEYEMED
SCDAG983Medicaid
GA5055266711OtherTRICARE
SCDAG983Medicaid