Provider Demographics
NPI:1871522045
Name:ATHENS EYE ASSOCIATES
Entity type:Organization
Organization Name:ATHENS EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-549-7047
Mailing Address - Street 1:1080 VEND DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7751
Mailing Address - Country:US
Mailing Address - Phone:706-549-7047
Mailing Address - Fax:706-613-5395
Practice Address - Street 1:1080 VEND DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7751
Practice Address - Country:US
Practice Address - Phone:706-549-7047
Practice Address - Fax:706-613-5395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053926174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00131029OtherRAILROAD RETIREMENT
GAGRP3531Medicare ID - Type UnspecifiedGROUP ID