Provider Demographics
NPI:1114046026
Name:BAY EYES SPECTACULAR, INC
Entity Type:Organization
Organization Name:BAY EYES SPECTACULAR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:GRAVLEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:251-990-9999
Mailing Address - Street 1:411 N SECTION ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2649
Mailing Address - Country:US
Mailing Address - Phone:251-990-9999
Mailing Address - Fax:251-990-9990
Practice Address - Street 1:411 N SECTION ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2649
Practice Address - Country:US
Practice Address - Phone:251-990-9999
Practice Address - Fax:251-990-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0527980001OtherMEDICARE LEGACY IDENTIFIER
AL510-58327OtherBLUE CROSS BLUE SHIELD
AL0527980001OtherMEDICARE LEGACY IDENTIFIER