Provider Demographics
NPI:1003251653
Name:FAMILY EYE CARE OF SYLACAUGA LLC
Entity Type:Organization
Organization Name:FAMILY EYE CARE OF SYLACAUGA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LEEANN
Authorized Official - Last Name:CANTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-507-1416
Mailing Address - Street 1:493 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-1916
Mailing Address - Country:US
Mailing Address - Phone:256-245-7696
Mailing Address - Fax:
Practice Address - Street 1:493 W 3RD ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-1916
Practice Address - Country:US
Practice Address - Phone:256-245-7696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-C54-TA-889152W00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty