1871717199 NPI number — RAINBOW CITY FAMILY EYE CARE LLC

Table of content: (NPI 1871717199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871717199 NPI number — RAINBOW CITY FAMILY EYE CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAINBOW CITY FAMILY EYE CARE 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:
6
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:
1871717199
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2040 2ND AVE E
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ONEONTA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35121-2731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-625-3937
Provider Business Mailing Address Fax Number:
205-466-7155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2040 2ND AVE E
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ONEONTA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35121-2731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-625-3937
Provider Business Practice Location Address Fax Number:
205-625-3938
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARRISON
Authorized Official First Name:
HAROLD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-625-3937

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  302 , 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: 009963650 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51504016 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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