Provider Demographics
NPI:1831393669
Name:MOUNTAIN EYE CARE, PC
Entity type:Organization
Organization Name:MOUNTAIN EYE CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN-MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-745-3900
Mailing Address - Street 1:253 HIGHWAY 515 E
Mailing Address - Street 2:BLDG C
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3697
Mailing Address - Country:US
Mailing Address - Phone:706-745-3900
Mailing Address - Fax:706-745-2705
Practice Address - Street 1:253 HIGHWAY 515 E
Practice Address - Street 2:BLDG C
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3697
Practice Address - Country:US
Practice Address - Phone:706-745-3900
Practice Address - Fax:706-745-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1355152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1679565444OtherINDIVIDUAL NPI
GA000515138AMedicaid
GA1679565444OtherINDIVIDUAL NPI
GA0528750001Medicare NSC
GAU35318Medicare UPIN