Provider Demographics
NPI:1083010888
Name:MOORES MILL EYECARE PC
Entity Type:Organization
Organization Name:MOORES MILL EYECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-521-7944
Mailing Address - Street 1:2415 MOORES MILL RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-8482
Mailing Address - Country:US
Mailing Address - Phone:334-521-7944
Mailing Address - Fax:334-521-7277
Practice Address - Street 1:2415 MOORES MILL RD
Practice Address - Street 2:SUITE 220
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-8482
Practice Address - Country:US
Practice Address - Phone:334-521-7944
Practice Address - Fax:334-521-7277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS931TA494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty