Provider Demographics
NPI:1114086055
Name:EAGLE VISION EYE CARE, INC.
Entity Type:Organization
Organization Name:EAGLE VISION EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-424-2733
Mailing Address - Street 1:5031 FORD PARKWAY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-5283
Mailing Address - Country:US
Mailing Address - Phone:205-424-2733
Mailing Address - Fax:205-424-0274
Practice Address - Street 1:5031 FORD PARKWAY
Practice Address - Street 2:SUITE 113
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-5283
Practice Address - Country:US
Practice Address - Phone:205-424-2733
Practice Address - Fax:205-424-0274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS848152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty