1750688941 NPI number — THE EYE DOCTOR,LLC

Table of content: (NPI 1750688941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750688941 NPI number — THE EYE DOCTOR,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE EYE DOCTOR,LLC
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:
STEVEN R FIELDS,O.D.
Provider Other Organization Name Type Code:
5
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:
1750688941
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
923 STAGE RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36830-5112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-740-9048
Provider Business Mailing Address Fax Number:
334-821-3776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
923 STAGE RD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36830-5109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-821-3700
Provider Business Practice Location Address Fax Number:
334-821-3776
Provider Enumeration Date:
02/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
FIELDS
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
334-740-9048

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  S 556 , 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)

  • Identifier: 009952480 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000058001 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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