Provider Demographics
NPI:1962087270
Name:EYE GUYS CAROLINA LLC
Entity type:Organization
Organization Name:EYE GUYS CAROLINA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-651-2020
Mailing Address - Street 1:1330 INTERSTATE PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-5625
Mailing Address - Country:US
Mailing Address - Phone:706-651-3905
Mailing Address - Fax:706-651-2032
Practice Address - Street 1:1330 INTERSTATE PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-5625
Practice Address - Country:US
Practice Address - Phone:706-651-3905
Practice Address - Fax:706-651-2032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE GUYS CAROLINA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty