Provider Demographics
NPI:1164609178
Name:DUDLEY EYE CARE, P.C.
Entity Type:Organization
Organization Name:DUDLEY EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARISA
Authorized Official - Middle Name:TACKETT
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-424-9608
Mailing Address - Street 1:3985 PARKWOOD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-5690
Mailing Address - Country:US
Mailing Address - Phone:205-424-9608
Mailing Address - Fax:205-424-9609
Practice Address - Street 1:3985 PARKWOOD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-5690
Practice Address - Country:US
Practice Address - Phone:205-424-9608
Practice Address - Fax:205-424-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSA81TA666152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6978560001Medicare NSC