Provider Demographics
NPI:1457520587
Name:ALTMAN EYE CLINIC, P.C.
Entity Type:Organization
Organization Name:ALTMAN EYE CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:229-868-6312
Mailing Address - Street 1:119 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:MC RAE
Mailing Address - State:GA
Mailing Address - Zip Code:31055-1668
Mailing Address - Country:US
Mailing Address - Phone:229-868-6312
Mailing Address - Fax:222-868-5330
Practice Address - Street 1:119 W PINE ST
Practice Address - Street 2:
Practice Address - City:MC RAE
Practice Address - State:GA
Practice Address - Zip Code:31055-1668
Practice Address - Country:US
Practice Address - Phone:229-868-6312
Practice Address - Fax:222-868-5330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000873152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAT97490OtherUPIN
GA0292400001Medicare NSC