Provider Demographics
NPI:1366808727
Name:EYE SITE OF OAKWOOD P.C.
Entity type:Organization
Organization Name:EYE SITE OF OAKWOOD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:SWOFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-310-0017
Mailing Address - Street 1:3640 MUNDY MILL ROAD
Mailing Address - Street 2:SUITE 146
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566
Mailing Address - Country:US
Mailing Address - Phone:470-290-8182
Mailing Address - Fax:470-290-8183
Practice Address - Street 1:3640 MUNDY MILL ROAD
Practice Address - Street 2:SUITE 146
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566
Practice Address - Country:US
Practice Address - Phone:470-290-8182
Practice Address - Fax:470-290-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA01214152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty