Provider Demographics
NPI:1700244472
Name:ALPHA AND OMEGA VISION CENTER
Entity Type:Organization
Organization Name:ALPHA AND OMEGA VISION CENTER
Other - Org Name:INSIGHT FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEWARD-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-546-5740
Mailing Address - Street 1:264 GUSTAV CT
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-8212
Mailing Address - Country:US
Mailing Address - Phone:803-546-5740
Mailing Address - Fax:
Practice Address - Street 1:3836 WASHINGTON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-5058
Practice Address - Country:US
Practice Address - Phone:706-410-2038
Practice Address - Fax:706-608-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002623152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD16310Medicaid
GA202I419915Medicare UPIN
SCD16310Medicaid