Provider Demographics
NPI:1962561928
Name:BATTLEFIELD OPTICAL DISPENSARY
Entity type:Organization
Organization Name:BATTLEFIELD OPTICAL DISPENSARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HULSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-866-2020
Mailing Address - Street 1:1052 BATTLEFIELD PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742
Mailing Address - Country:US
Mailing Address - Phone:706-866-2020
Mailing Address - Fax:706-866-6890
Practice Address - Street 1:1052 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3948
Practice Address - Country:US
Practice Address - Phone:706-866-2020
Practice Address - Fax:706-866-6890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0144860001Medicare ID - Type Unspecified