Provider Demographics
NPI:1770771164
Name:PROCARE EYE CENTER
Entity type:Organization
Organization Name:PROCARE EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SCHIRACK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-924-3355
Mailing Address - Street 1:6572 HIGHWAY 92
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-7562
Mailing Address - Country:US
Mailing Address - Phone:770-924-3355
Mailing Address - Fax:770-928-1205
Practice Address - Street 1:6572 HIGHWAY 92
Practice Address - Street 2:SUITE 100
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-7562
Practice Address - Country:US
Practice Address - Phone:770-924-3355
Practice Address - Fax:770-928-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000OPT1060152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004640859OtherAETNA
437724OtherCOVENTRY
52101354001OtherBCBS
=========OtherUNITED HEALTH CARE
0829120001Medicare NSC
=========OtherUNITED HEALTH CARE