Provider Demographics
NPI:1346318912
Name:ST. CLAIR EYE CARE LLC
Entity Type:Organization
Organization Name:ST. CLAIR EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEIGH
Authorized Official - Middle Name:MCVICKER
Authorized Official - Last Name:BUCKINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-640-3091
Mailing Address - Street 1:2824 MOODY PKWY
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-3101
Mailing Address - Country:US
Mailing Address - Phone:205-640-3091
Mailing Address - Fax:205-640-3092
Practice Address - Street 1:2824 MOODY PKWY
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-3101
Practice Address - Country:US
Practice Address - Phone:205-640-3091
Practice Address - Fax:205-640-3092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS951TA530152W00000X
ALS970TA531152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529906420Medicaid