Provider Demographics
NPI:1780049221
Name:OCONEE VISION GROUP, LLC
Entity type:Organization
Organization Name:OCONEE VISION GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-769-4404
Mailing Address - Street 1:2281 HOG MOUNTAIN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4846
Mailing Address - Country:US
Mailing Address - Phone:706-769-4404
Mailing Address - Fax:706-769-0687
Practice Address - Street 1:2281 HOG MOUNTAIN RD
Practice Address - Street 2:SUITE C
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4846
Practice Address - Country:US
Practice Address - Phone:706-769-4404
Practice Address - Fax:706-769-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty