NPIMap

Organization Active NPI

Eye Specialists of America, LLC

  • Multi-Specialty Clinic/Center
  • Athens, GA
National Provider Identifier
1710670286
Registry record updated Jul 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
EYE SPECIALISTS OF AMERICA, LLC
Practice address
1620 Prince Ave
Athens, GA 30606-6008
Phone
(706) 546-0170
Fax
(706) 546-5015
NPI assigned
May 31, 2023
Last updated
Jul 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Centrael T Evans, MDNPI 1902249139
Title
Managing Member
Phone
(706) 546-0170

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

1620 Prince Ave
Athens, GA 30606-6008

Mailing address

1620 Prince Ave
Athens, GA 30606-6008

Other practice location 1

1030 Founders Row
Suite C
Greensboro, GA 30642-5334
Phone (706) 546-0170 ext. 203

Other practice location 2

1871 N Elm St
Commerce, GA 30529-2349
Phone (706) 546-0170

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231205002509 GA Part B Supplier - Clinic/Group Practice 4880043686 Receives reassigned benefits from 2 practitioners
Practice locations: Athens, GA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689638400000",
    "number": "1710670286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 PRINCE AVE",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306066008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 PRINCE AVE",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306066008",
            "telephone_number": "706-546-0170",
            "fax_number": "706-546-5015"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1030 Founders Row",
            "address_2": "Suite C",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "GA",
            "postal_code": "306425334",
            "country_code": "US",
            "telephone_number": "706-546-0170 x203",
            "fax_number": "706-546-5015",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1871 N Elm St",
            "address_purpose": "LOCATION",
            "city": "Commerce",
            "state": "GA",
            "postal_code": "305292349",
            "country_code": "US",
            "telephone_number": "706-546-0170",
            "fax_number": "706-546-5015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EYE SPECIALISTS OF AMERICA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-31",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "CENTRAEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "706-546-0170",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.