Provider Demographics
NPI:1336262112
Name:CLAYTON FAMILY EYE CARE PC
Entity Type:Organization
Organization Name:CLAYTON FAMILY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:THURMOND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-782-3535
Mailing Address - Street 1:PO BOX 2105
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-0053
Mailing Address - Country:US
Mailing Address - Phone:706-782-3535
Mailing Address - Fax:706-782-7525
Practice Address - Street 1:50 EARL ST.
Practice Address - Street 2:SUITE A
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525
Practice Address - Country:US
Practice Address - Phone:706-782-3535
Practice Address - Fax:706-782-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001354152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52403378OtherBLUECROSS BLUESHIELD
GA00521562AMedicaid
GA410024148OtherRAIL ROAD MEDICARE
GA410024148OtherRAIL ROAD MEDICARE
GAU37493Medicare UPIN
GA0567940001Medicare NSC