Provider Demographics
NPI:1548651920
Name:TIFT EYE CARE, LLC
Entity type:Organization
Organization Name:TIFT EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEBECK
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:229-382-4441
Mailing Address - Street 1:363 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4813
Mailing Address - Country:US
Mailing Address - Phone:229-382-4441
Mailing Address - Fax:229-386-0211
Practice Address - Street 1:363 MAIN ST S
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4813
Practice Address - Country:US
Practice Address - Phone:229-382-4441
Practice Address - Fax:229-386-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002502332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier