Provider Demographics
NPI:1952569279
Name:NORTH GEORGIA VISION CENTER INC
Entity Type:Organization
Organization Name:NORTH GEORGIA VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-375-1720
Mailing Address - Street 1:8390 N HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRING
Mailing Address - State:GA
Mailing Address - Zip Code:30739-2103
Mailing Address - Country:US
Mailing Address - Phone:706-375-1720
Mailing Address - Fax:706-375-1729
Practice Address - Street 1:8390 N HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:ROCK SPRING
Practice Address - State:GA
Practice Address - Zip Code:30739-2103
Practice Address - Country:US
Practice Address - Phone:706-375-1720
Practice Address - Fax:706-375-1729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002352152W00000X
TNOD0000002478152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
205370293OtherNVA
GA41ZCGGNOtherMEDICARE
59526OtherDAVIS VISION
911517OtherEYE MED
TN4115539OtherBCBS
45460OtherSPECTERA
101846OtherAVESIS
33901OtherOPTI CARE
41ZCGGNOtherMEDICARE GA
194699738AOtherMEDICARE GA
927618OtherBLOCK VISION LOCATION NUMBER 114419
GA194699738AMedicaid
927618OtherBLOCK VISION LOCATION NUMBER 114419
911517OtherEYE MED
=========OtherSUPERIOR
GA=========OtherBCBS
=========OtherBCBS
205370293OtherNVA
33901OtherOPTI CARE
=========OtherCIGNA
=========OtherBEACH STREET
=========OtherHEALTH ONE
=========OtherUNITED HEALTHCARE
U98901Medicare UPIN