Provider Demographics
NPI:1588788418
Name:CITY OPTICAL INC
Entity type:Organization
Organization Name:CITY OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:LDO
Authorized Official - Phone:229-382-9751
Mailing Address - Street 1:211 LOVE AVE
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4453
Mailing Address - Country:US
Mailing Address - Phone:229-382-9751
Mailing Address - Fax:229-382-9775
Practice Address - Street 1:211 LOVE AVE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4453
Practice Address - Country:US
Practice Address - Phone:229-382-9751
Practice Address - Fax:229-382-9775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1410156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty