Organization
OPTICAL SHOP AT ATHENS EYE ASSOCIATES, INC.
Active
Parent organization
ATHENS EYE ASSOCIATES, P.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
ATHENS EYE ASSOCIATES, P.C.
Authorized official
MICHAEL S. JACOBS M.D. (PRESIDENT)
(706) 549-7047
Entity
Organization
Contact information
Practice address
1080 VEND DR, SUITE 100, BOGART, GA 30622-3051
(706) 549-7047
(706) 613-5395
Mailing address
1080 VEND DR, SUITE 100, BOGART, GA 30622-3051
(706) 549-7047
(706) 613-5395
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6325700001
HUMANA
GA
Enumeration date
01/31/2009
Last updated
08/29/2012
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