Provider Demographics
NPI:1871613554
Name:GEORGIA EYE INSTITUTE, INC.
Entity type:Organization
Organization Name:GEORGIA EYE INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-350-9335
Mailing Address - Street 1:PO BOX 931989
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-0001
Mailing Address - Country:US
Mailing Address - Phone:843-705-3333
Mailing Address - Fax:843-705-3334
Practice Address - Street 1:4 OKATIE CENTER BLVD. S
Practice Address - Street 2:BLDG. 6 SUITE 102
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-7515
Practice Address - Country:US
Practice Address - Phone:843-705-3333
Practice Address - Fax:843-705-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty