Myeyedr Optometry of Georgia, LLC
Organization Active NPI Optometrist · East Ellijay, GA
NPI 1750107561 · NPPES record last updated Nov 26, 2024
Key facts
- NPI
- 1750107561
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- MYEYEDR OPTOMETRY OF GEORGIA, LLC
- Practice address
- 772 Maddox Dr Ste 132
East Ellijay, GA 30540-8196 - Phone
- (706) 276-4455
- Fax
- (706) 276-4458
- NPI assigned
- Nov 26, 2024
- Organization subpart
- No
Authorized official
- Name
- Sue Downes
- Title
- Secretary
- Phone
- (703) 847-8899
Corporate family (same tax ID) 42
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140428000739 | GA | Part B Supplier - Clinic/Group Practice | 8224261201 |
Receives reassigned benefits from 207 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Myeyedr Optometry of Ga
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
772 Maddox Dr Ste 132
East Ellijay, GA 30540-8196
Mailing address
8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899
Other names
- MyEyeDr.
Other providers in East Ellijay, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.