Provider Demographics
NPI:1609768464
Name:WILDWOOD EYE CARE LLC
Entity type:Organization
Organization Name:WILDWOOD EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-952-6412
Mailing Address - Street 1:76 BETHEL DRIVE
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-9435
Mailing Address - Country:US
Mailing Address - Phone:706-531-9900
Mailing Address - Fax:
Practice Address - Street 1:76 BETHEL DRIVE
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-9435
Practice Address - Country:US
Practice Address - Phone:706-531-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty