Basic Information
| Provider Information | |||||||||
| NPI: | 1316593759 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYE PHYSICIANS AND SURGEONS OF AUGUSTA, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1330 INTERSTATE PKWY | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309095625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066512020 | ||||||||
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| Practice Location | |||||||||
| Address1: | 792 SILVER BLUFF RD | ||||||||
| Address2: | |||||||||
| City: | AIKEN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 298036055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036429902 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2019 | ||||||||
| LastUpdateDate: | 08/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | BERTRAM | ||||||||
| AuthorizedOfficialFirstName: | BRADLEY | ||||||||
| AuthorizedOfficialMiddleName: | ALAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7066512020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EYE PHYSICIANS & SURGEONS OF AUGUSTA, PC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.