Provider Demographics
NPI:1336432251
Name:IDOC HOLDINGS LLC
Entity Type:Organization
Organization Name:IDOC HOLDINGS LLC
Other - Org Name:MCDONALD EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OCECLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-657-7559
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-0156
Mailing Address - Country:US
Mailing Address - Phone:706-657-7559
Mailing Address - Fax:
Practice Address - Street 1:5377 HIGHWAY 136
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-2900
Practice Address - Country:US
Practice Address - Phone:706-657-7559
Practice Address - Fax:706-657-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3597761Medicare PIN
TNU28541Medicare UPIN