Provider Demographics
NPI:1902145873
Name:MOBLEY EYE CARE OF SHARPSBURG
Entity Type:Organization
Organization Name:MOBLEY EYE CARE OF SHARPSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-304-2025
Mailing Address - Street 1:3339 HIGHWAY 34 E
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-3564
Mailing Address - Country:US
Mailing Address - Phone:770-304-2025
Mailing Address - Fax:
Practice Address - Street 1:3339 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-3564
Practice Address - Country:US
Practice Address - Phone:770-304-2025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000912152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty