1720040843 NPI number — FAMILY EYECARE ASSOCIATES OF MILLEDGEVILLE, PC

Table of content: MR. MARK KENDALL BATES RVT (NPI 1750573192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720040843 NPI number — FAMILY EYECARE ASSOCIATES OF MILLEDGEVILLE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY EYECARE ASSOCIATES OF MILLEDGEVILLE, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720040843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 FIELDSTONE DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MILLEDGEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31061-7106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-453-9333
Provider Business Mailing Address Fax Number:
478-453-7760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 FIELDSTONE DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MILLEDGEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31061-7106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-453-9333
Provider Business Practice Location Address Fax Number:
478-453-7760
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCQUAIG
Authorized Official First Name:
C.
Authorized Official Middle Name:
STEVE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
478-453-9333

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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