Provider Demographics
NPI:1700171394
Name:THOMAS EYE GROUP PC
Entity Type:Organization
Organization Name:THOMAS EYE GROUP PC
Other - Org Name:THOMAS EYE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-781-7373
Mailing Address - Street 1:285 BOULEVARD NE STE 540
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4214
Mailing Address - Country:US
Mailing Address - Phone:404-582-0096
Mailing Address - Fax:404-589-8920
Practice Address - Street 1:285 BOULEVARD NE STE 540
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4214
Practice Address - Country:US
Practice Address - Phone:404-582-0096
Practice Address - Fax:404-589-8920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2583Medicare PIN