Provider Demographics
NPI:1285358770
Name:ORDER MEDICAID GLASSES ONLINE
Entity type:Organization
Organization Name:ORDER MEDICAID GLASSES ONLINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCASKILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-663-3015
Mailing Address - Street 1:470 DACULA RD UNIT 879
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-0108
Mailing Address - Country:US
Mailing Address - Phone:678-663-3015
Mailing Address - Fax:
Practice Address - Street 1:1890 BROWNING BEND CT
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7771
Practice Address - Country:US
Practice Address - Phone:678-663-3015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty