Provider Demographics
NPI:1093996951
Name:MONTGOMERY EYE PHYSICIANS P.C
Entity Type:Organization
Organization Name:MONTGOMERY EYE PHYSICIANS P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLYN
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-271-3804
Mailing Address - Street 1:2752 ZELDA RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2694
Mailing Address - Country:US
Mailing Address - Phone:334-271-3804
Mailing Address - Fax:334-270-3375
Practice Address - Street 1:8131 SEATON PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-7205
Practice Address - Country:US
Practice Address - Phone:334-323-1889
Practice Address - Fax:334-270-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH444Medicare PIN