Provider Demographics
NPI:1174988232
Name:PROFESSIONAL EYE ASSOCIATES, INC.
Entity type:Organization
Organization Name:PROFESSIONAL EYE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:DIXON
Authorized Official - Last Name:CURD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-226-2020
Mailing Address - Street 1:1111 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2588
Mailing Address - Country:US
Mailing Address - Phone:706-226-2020
Mailing Address - Fax:706-529-3322
Practice Address - Street 1:1052 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3948
Practice Address - Country:US
Practice Address - Phone:706-226-2020
Practice Address - Fax:706-529-3322
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROFESSIONAL EYE ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO001437332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP 976Medicare UPIN