Basic Information
| Provider Information | |||||||||
| NPI: | 1952360646 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PRECISION OPTICAL P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4521 17TH AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066600191 | ||||||||
| FaxNumber: | 7065968388 | ||||||||
| Practice Location | |||||||||
| Address1: | 4521 17TH AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066600191 | ||||||||
| FaxNumber: | 7065968388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 05/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | ROSS | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | ADKINS | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER OPTIMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 7066600191 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O. D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
No ID Information.