Provider Demographics
NPI:1093835431
Name:MEDICAL ARTS EYE CLINIC, PC
Entity Type:Organization
Organization Name:MEDICAL ARTS EYE CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRYE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-749-1486
Mailing Address - Street 1:1805 LAKESIDE CIR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-2825
Mailing Address - Country:US
Mailing Address - Phone:334-821-3838
Mailing Address - Fax:334-749-1748
Practice Address - Street 1:1805 LAKESIDE CIR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-2825
Practice Address - Country:US
Practice Address - Phone:334-821-3838
Practice Address - Fax:334-749-1748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG992Medicare ID - Type UnspecifiedGROUP NUMBER