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Organization

PINE MOUNTAIN EYE CARE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARK P SMITH O.D. (OWNER)
(706) 663-2600
Entity
Organization

Contact information

Practice address
414 S MAIN AVE, PINE MOUNTAIN, GA 31822-2355
(706) 663-2600
(706) 663-7632
Mailing address
414 SOUTH MAIN AVENUE, PINE MOUNTAIN, GA 31822
(706) 663-2600
(706) 663-7632

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT001254
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00451162G
GA
01
P00253929
RAILROAD MEDICARE
GA
Enumeration date
04/11/2007
Last updated
01/28/2011
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