1164609178 NPI number — DUDLEY EYE CARE, P.C.

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 1164609178 NPI number — DUDLEY EYE CARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUDLEY EYE CARE, P.C.
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:
1164609178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3985 PARKWOOD RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
BESSEMER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35022-5690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-424-9608
Provider Business Mailing Address Fax Number:
205-424-9609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3985 PARKWOOD RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BESSEMER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35022-5690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-424-9608
Provider Business Practice Location Address Fax Number:
205-424-9609
Provider Enumeration Date:
01/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DUDLEY
Authorized Official First Name:
PARISA
Authorized Official Middle Name:
TACKETT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-424-9608

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  SA81TA666 , 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)





Copyright © 2007-2025 www.npivalidator.com