Provider Demographics
NPI:1053478701
Name:EUFAULA EYE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:EUFAULA EYE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENAVIDES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-687-2545
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36072-0635
Mailing Address - Country:US
Mailing Address - Phone:334-687-2545
Mailing Address - Fax:334-687-6491
Practice Address - Street 1:138 E BROAD ST
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-2024
Practice Address - Country:US
Practice Address - Phone:334-687-2545
Practice Address - Fax:334-687-6491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS387TA013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000267495BMedicaid
AL528802120Medicaid
AL000059471Medicaid
AL51059471OtherBCBS OF AL
GA000267495BMedicaid
0161840001Medicare NSC
T69129Medicare UPIN
180006842Medicare PIN