Provider Demographics
NPI:1144517905
Name:COUSINS EYE CARE, P.C.
Entity type:Organization
Organization Name:COUSINS EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COUSINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-343-1403
Mailing Address - Street 1:1020 WHISPERING LAKES TRL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-6326
Mailing Address - Country:US
Mailing Address - Phone:706-343-1403
Mailing Address - Fax:
Practice Address - Street 1:1681 EATONTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-4632
Practice Address - Country:US
Practice Address - Phone:706-342-8018
Practice Address - Fax:706-342-8015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002288152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty