Organization
CASELLA EYE CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS VICTOR CASELLA OD (CEO)
(706) 722-0817
Entity
Organization
Contact information
Practice address
767 BROAD ST, AUGUSTA, GA 30901-1329
(706) 722-0817
Mailing address
767 BROAD ST, AUGUSTA, GA 30901-1329
(706) 722-0817
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
852
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DAG999
—
SC
Enumeration date
12/05/2006
Last updated
04/15/2008
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