Provider Demographics
NPI:1295995835
Name:GS EYECARE
Entity type:Organization
Organization Name:GS EYECARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:K
Authorized Official - Last Name:GABRELS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-844-8411
Mailing Address - Street 1:184 TRI COUNTY PLZ
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2729
Mailing Address - Country:US
Mailing Address - Phone:770-844-8411
Mailing Address - Fax:770-889-2191
Practice Address - Street 1:184 TRI COUNTY PLZ
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2729
Practice Address - Country:US
Practice Address - Phone:770-844-8411
Practice Address - Fax:770-889-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAL20063005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00069825AMedicaid
GA92534Medicaid
GA101533Medicaid
GA000873232AMedicaid
GA41 ZCDRJMedicare PIN
GA41ZCBMSMedicare PIN
GA101533Medicaid
GA000873232AMedicaid