Organization
AMERICAN EYECARE CENTER OF JESUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES DERRYL THOMAS O.D. (PRES.)
(912) 530-6000
Entity
Organization
Contact information
Practice address
198 SW BROAD ST, JESUP, GA 31545-1101
(912) 530-6000
(912) 530-6044
Mailing address
198 SW BROAD ST, JESUP, GA 31545-1101
(912) 530-6000
(912) 530-6044
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00461876B
—
GA
05
—
00461876D
—
GA
01
—
410026823
RAILROAD MEDICARE
GA
Enumeration date
11/30/2006
Last updated
03/26/2013
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