Organization
WOLF CREEK ENT LLC
Active
Other names
CATHY'S EYE CARE
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN STEWART FRAZIER (BOOKKEEPER)
(478) 986-6983
Entity
Organization
Contact information
Practice address
1841 N COLUMBIA ST, MILLEDGEVILLE, GA 31061-2382
(478) 452-3593
(478) 936-9992
Mailing address
1841 N COLUMBIA ST, MILLEDGEVILLE, GA 31061-2382
(478) 452-3593
(478) 936-9992
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
LDO001648
GA
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
GA
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00897487A
—
GA
01
—
07820
SPECTERA
GA
01
—
100921
AVESIS MCAID
GA
01
—
25391
AVESIS
GA
Enumeration date
05/11/2007
Last updated
05/13/2008
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