Organization
BAXLEY EYECARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMILY E KANAVAGE (OFFICE MANAGER)
(912) 537-2020
Entity
Organization
Contact information
Practice address
18 LUCKIE ST STE C, SUTIE C, BAXLEY, GA 31513-0358
(912) 367-6863
(912) 367-0775
Mailing address
206 MAPLE DR, VIDALIA, GA 30474-8907
(912) 537-2020
(912) 537-7935
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1223
GA
Other
Enumeration date
05/11/2009
Last updated
05/11/2009
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