Provider Demographics
NPI:1104948678
Name:PARKWAY EYE CLINIC, INC.
Entity type:Organization
Organization Name:PARKWAY EYE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:OHLSSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-366-1806
Mailing Address - Street 1:559 FOREST PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-2116
Mailing Address - Country:US
Mailing Address - Phone:404-366-1806
Mailing Address - Fax:404-361-2203
Practice Address - Street 1:559 FOREST PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-2116
Practice Address - Country:US
Practice Address - Phone:404-366-1806
Practice Address - Fax:404-361-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1111332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
T97763Medicare UPIN
GA385407507AMedicare ID - Type UnspecifiedMEDICARE NUIMBER