1881618403 NPI number — BAY EYES SURGERY CENTER

Table of content: (NPI 1881618403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881618403 NPI number — BAY EYES SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY EYES SURGERY CENTER
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:
VISIONARY USA.COM SURGERY INSTITUTE
Provider Other Organization Name Type Code:
3
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:
1881618403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2020
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRHOPE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36533-2020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-990-3937
Provider Business Mailing Address Fax Number:
251-990-9990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 NORTH SECTION STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRHOPE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-990-3937
Provider Business Practice Location Address Fax Number:
251-990-9990
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRAVLEE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER/ DOCTOR
Authorized Official Telephone Number:
251-990-3937

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X , with the licence number:  12947 , 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: 051557682 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2721198 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510-04612 . This is a "BLUE CROSS BLUE SHIEDL OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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