Provider Demographics
NPI:1962576165
Name:MORRIS OPTICIANS AND HEARING AID CENTER
Entity type:Organization
Organization Name:MORRIS OPTICIANS AND HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS CLAIMS ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:T
Authorized Official - Last Name:TISDALE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:803-564-5340
Mailing Address - Street 1:3839 WASHINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-5178
Mailing Address - Country:US
Mailing Address - Phone:706-860-9800
Mailing Address - Fax:706-860-9209
Practice Address - Street 1:3839 WASHINGTON ROAD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-5178
Practice Address - Country:US
Practice Address - Phone:706-860-9800
Practice Address - Fax:706-860-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237700000X, 332B00000X
GA643332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies