Provider Demographics
NPI:1932126455
Name:GEORGIA-FLORIDA EYE CENTERS, P.C.
Entity Type:Organization
Organization Name:GEORGIA-FLORIDA EYE CENTERS, P.C.
Other - Org Name:MOULTRIE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-226-6000
Mailing Address - Street 1:2282 E PINETREE BLVD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4807
Mailing Address - Country:US
Mailing Address - Phone:229-226-6000
Mailing Address - Fax:229-226-5859
Practice Address - Street 1:2375 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6517
Practice Address - Country:US
Practice Address - Phone:229-891-2020
Practice Address - Fax:229-890-7741
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGIA-FLORIDA EYE CENTERS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-17
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO000362332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000479696AMedicaid
GA4785150001Medicare NSC