Provider Demographics
NPI:1861871725
Name:THE EYECARE PLACE LLC
Entity type:Organization
Organization Name:THE EYECARE PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHHAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEI
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:678-782-7952
Mailing Address - Street 1:42 OLD JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-3029
Mailing Address - Country:US
Mailing Address - Phone:678-782-7952
Mailing Address - Fax:678-782-7954
Practice Address - Street 1:42 OLD JACKSON RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-3029
Practice Address - Country:US
Practice Address - Phone:678-782-7952
Practice Address - Fax:678-782-7954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002144156FX1800X
GAOPT001522152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty