Provider Demographics
NPI:1487928701
Name:FRANKLIN COUNTY EYE CARE
Entity type:Organization
Organization Name:FRANKLIN COUNTY EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RICK
Authorized Official - Last Name:VANDERHOEF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-356-0206
Mailing Address - Street 1:13375 JONES ST
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:LAVONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30553-1147
Mailing Address - Country:US
Mailing Address - Phone:706-356-0206
Mailing Address - Fax:706-356-0346
Practice Address - Street 1:13375 JONES ST
Practice Address - Street 2:SUITE B-2
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-1147
Practice Address - Country:US
Practice Address - Phone:706-356-0206
Practice Address - Fax:706-356-0346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHENS COUNTY EYE CLINIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-05
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000743003DMedicaid
GA000743003DMedicaid
41ZCDJMMedicare UPIN