Provider Demographics
NPI:1063624997
Name:EYE CENTER OPTICAL, LLC
Entity type:Organization
Organization Name:EYE CENTER OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEESLING
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:229-244-3000
Mailing Address - Street 1:PO BOX 3223
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31604-3223
Mailing Address - Country:US
Mailing Address - Phone:229-244-2790
Mailing Address - Fax:
Practice Address - Street 1:2108 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2947
Practice Address - Country:US
Practice Address - Phone:229-244-2790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty