Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 145 Second St, Cochran, Georgia |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1952551541 | NPI | - | NPPES |
00055767F | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | OPT000731 (Georgia) | Primary |
Mailing Address | Practice Location Address |
---|---|
Po Box 498, Cochran, GA 31014-0498 Ph: (478) 934-8848 | 145 Second St, Cochran, GA 31014 Ph: (478) 934-8848 |