Provider Demographics
NPI:1508419714
Name:FICEK, TAYLOR (OD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:FICEK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:BEGASSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:129 COLHAM FERRY RD
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-2619
Mailing Address - Country:US
Mailing Address - Phone:402-525-2056
Mailing Address - Fax:
Practice Address - Street 1:1725 ELECTRIC AVE STE 100A
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-2608
Practice Address - Country:US
Practice Address - Phone:706-237-9128
Practice Address - Fax:706-237-9129
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003161152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist