1336179209 NPI number — GREENE COUNTY EYE CLINIC, LLC

Table of content: ELIZABETH RODRIGUEZ ARCEL LMFT (NPI 1578763652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336179209 NPI number — GREENE COUNTY EYE CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENE COUNTY EYE CLINIC, 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:
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:
1336179209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 229
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUTAW
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35462-0229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-372-5070
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 WILSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUTAW
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35462-1064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-372-5070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARDEN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-372-5070

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  S426TA020 , 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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