1114086055 NPI number — EAGLE VISION EYE CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114086055 NPI number — EAGLE VISION EYE CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAGLE VISION EYE CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114086055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5031 FORD PARKWAY
Provider Second Line Business Mailing Address:
SUITE 113
Provider Business Mailing Address City Name:
BESSEMER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35022-5283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-424-2733
Provider Business Mailing Address Fax Number:
205-424-0274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5031 FORD PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
BESSEMER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35022-5283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-424-2733
Provider Business Practice Location Address Fax Number:
205-424-0274
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEEKS
Authorized Official First Name:
RAPHAEL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-424-2733

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  S848 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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