Provider Demographics
NPI:1346340627
Name:MCDONOUGH VISION CARE LLC
Entity type:Organization
Organization Name:MCDONOUGH VISION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:770-957-6611
Mailing Address - Street 1:183 KEYS FERRY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3232
Mailing Address - Country:US
Mailing Address - Phone:770-957-6611
Mailing Address - Fax:
Practice Address - Street 1:183 KEYS FERRY ST
Practice Address - Street 2:SUITE A
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3232
Practice Address - Country:US
Practice Address - Phone:770-957-6611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000897152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52150230OtherBCBS
GAGRP7089Medicare ID - Type Unspecified
GAU17361Medicare UPIN