Provider Demographics
NPI:1992947717
Name:FOR YOUR EYES ONLY-EYE CARE INC
Entity type:Organization
Organization Name:FOR YOUR EYES ONLY-EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRA
Authorized Official - Middle Name:KALMAN
Authorized Official - Last Name:SIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-682-9299
Mailing Address - Street 1:5851 S VICKERY ST.
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8793
Mailing Address - Country:US
Mailing Address - Phone:678-682-9299
Mailing Address - Fax:
Practice Address - Street 1:5851 S VICKERY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8793
Practice Address - Country:US
Practice Address - Phone:678-682-9299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2413152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G707327Medicare PIN
GA511I410095Medicare PIN
GA202G707327Medicare Oscar/Certification