Organization
EAST GA REGIONAL EYE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK ROBERT TENZEL M.D. (PRESIDENT)
(912) 764-6357
Entity
Organization
Contact information
Practice address
21 N ZETTEROWER AVE, STATESBORO, GA 30458-7142
(912) 764-6357
(912) 764-2192
Mailing address
21 N ZETTEROWER AVE, STATESBORO, GA 30458-7142
(912) 764-6357
(912) 764-2192
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
045642
GA
Other
Enumeration date
01/18/2007
Last updated
10/18/2007
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