Provider Demographics
NPI:1831251826
Name:NORTH COLUMBUS EYE CENTER, PC
Entity type:Organization
Organization Name:NORTH COLUMBUS EYE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:CERAVOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-323-8127
Mailing Address - Street 1:1240 BROOKSTONE CENTRE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2988
Mailing Address - Country:US
Mailing Address - Phone:706-323-8127
Mailing Address - Fax:706-596-4839
Practice Address - Street 1:1240 BROOKSTONE CENTRE PARKWAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-2988
Practice Address - Country:US
Practice Address - Phone:706-323-8127
Practice Address - Fax:706-596-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000979349AMedicaid
GA000979349AMedicaid
GAF22089Medicare UPIN