Organization
PRIMARY EYECARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LETA M BIRD (BLLING MANAGER)
(478) 475-1600
Entity
Organization
Contact information
Practice address
627 S HOUSTON LAKE RD, SUITE 100, WARNER ROBINS, GA 31088-9077
(478) 322-0009
Mailing address
3801 NORTHSDIE DR, MACON, GA 31201
(478) 475-1600
(478) 475-4160
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
08/20/2007
Last updated
01/03/2008
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