Provider Demographics
NPI:1982747622
Name:VISION CENTER OF BRUNSWICK, INC
Entity Type:Organization
Organization Name:VISION CENTER OF BRUNSWICK, INC
Other - Org Name:VISION CENTER OF BRUNSIWCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CALHOUN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:II
Authorized Official - Credentials:LDO
Authorized Official - Phone:912-264-2020
Mailing Address - Street 1:2400 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4721
Mailing Address - Country:US
Mailing Address - Phone:912-264-2020
Mailing Address - Fax:912-265-7777
Practice Address - Street 1:2400 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4721
Practice Address - Country:US
Practice Address - Phone:912-264-2020
Practice Address - Fax:912-265-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1232156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA41ZCDTFMedicare ID - Type Unspecified