Provider Demographics
NPI:1205865938
Name:EAGLE VISION LLC
Entity Type:Organization
Organization Name:EAGLE VISION LLC
Other - Org Name:AUBURN EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LEHMAN
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:334-821-8889
Mailing Address - Street 1:1955 OPELIKA RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-2811
Mailing Address - Country:US
Mailing Address - Phone:334-821-8889
Mailing Address - Fax:334-821-4733
Practice Address - Street 1:1955 OPELIKA RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-2811
Practice Address - Country:US
Practice Address - Phone:334-821-8889
Practice Address - Fax:334-821-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-504-TA-106152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5832620001Medicare NSC