Provider Demographics
NPI:1366634941
Name:BOOZER EYECARE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:BOOZER EYECARE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:BOOZER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-739-4000
Mailing Address - Street 1:1000 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-4934
Mailing Address - Country:US
Mailing Address - Phone:256-739-4000
Mailing Address - Fax:256-734-1390
Practice Address - Street 1:1000 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-4934
Practice Address - Country:US
Practice Address - Phone:256-739-4000
Practice Address - Fax:256-734-1390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS 541 TA 016152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529932876Medicaid
AL515-44928OtherBC BS AL
AL510I410021Medicare PIN
AL6106240001Medicare NSC
AL510G700043Medicare PIN
AL515-44928OtherBC BS AL