Provider Demographics
NPI:1215047683
Name:THOMAS EYE GROUP PC
Entity type:Organization
Organization Name:THOMAS EYE GROUP PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-781-7373
Mailing Address - Street 1:5901A PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:STE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5382
Mailing Address - Country:US
Mailing Address - Phone:678-892-2020
Mailing Address - Fax:678-538-1950
Practice Address - Street 1:149 TOWNE LAKE PKWY STE 102
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4850
Practice Address - Country:US
Practice Address - Phone:770-928-4544
Practice Address - Fax:770-928-8609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACB9489OtherRR MEDICARE
GACB9489OtherRR MEDICARE
GAGRP2583Medicare PIN