Provider Demographics
NPI:1093999831
Name:FLORENCE EYE CENTER, INC
Entity Type:Organization
Organization Name:FLORENCE EYE CENTER, INC
Other - Org Name:TUSCUMBIA EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:RAYFORD
Authorized Official - Last Name:BASDEN
Authorized Official - Suffix:
Authorized Official - Credentials:O,D,
Authorized Official - Phone:256-383-2121
Mailing Address - Street 1:506 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-2049
Mailing Address - Country:US
Mailing Address - Phone:256-383-2121
Mailing Address - Fax:256-383-2131
Practice Address - Street 1:506 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-2049
Practice Address - Country:US
Practice Address - Phone:256-383-2121
Practice Address - Fax:256-383-2131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORENCE EYE CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-27
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-722-TA-009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009933175Medicaid
AL0663380002OtherDMERC
AL009933175Medicaid