Basic Information
| Provider Information | |||||||||
| NPI: | 1154422152 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN EYE CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6490 VETERANS PKWY | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319093567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066536202 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6490 VETERANS PARKWAY | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319093567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066536202 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 03/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | HOPKINS | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | DALE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7066536202 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 055003136A | 05 | GA | MEDICAID |