| |
109 12th St, Columbus, GA 31901-5245 | |
(706) 322-5528 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 109 12th St, Columbus, Georgia |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1235553157 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | OPT002724 (Georgia) | Secondary |
332H00000X | Eyewear Supplier | OPT002724 (Georgia) | Primary |
Mailing Address | Practice Location Address |
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109 12th St, Columbus, GA 31901-5245 Ph: (706) 322-5528 | 109 12th St, Columbus, GA 31901-5245 Ph: (706) 322-5528 |