Organization
SISTAR EYECARE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES LEON SISTER JR. OD (OPTOMETRIST CEO)
(912) 285-0020
Entity
Organization
Contact information
Practice address
545 KNIGHT AVE, WAYCROSS, GA 31501-3354
(912) 285-0020
(912) 285-8222
Mailing address
PO BOX 1465, 545 KNIGHT AVE, WAYCROSS, GA 31502-1465
(912) 285-0020
(912) 285-8222
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
919T
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00204663D
—
GA
01
—
52194992
BCBS
GA
Enumeration date
03/10/2006
Last updated
02/14/2008
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