Provider Demographics
NPI:1265040273
Name:CHEROKEE EYE CLINIC CO, INC
Entity Type:Organization
Organization Name:CHEROKEE EYE CLINIC CO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:MCKISSICK
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:256-484-2151
Mailing Address - Street 1:280 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTRE
Mailing Address - State:AL
Mailing Address - Zip Code:35960-1326
Mailing Address - Country:US
Mailing Address - Phone:256-927-4030
Mailing Address - Fax:256-927-2586
Practice Address - Street 1:280 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960-1326
Practice Address - Country:US
Practice Address - Phone:256-927-4030
Practice Address - Fax:256-927-2586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty