Provider Demographics
NPI:1376738203
Name:BAY EYES SPECTACULAR INC.
Entity Type:Organization
Organization Name:BAY EYES SPECTACULAR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTHAMOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:GRAVLEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:251-943-3937
Mailing Address - Street 1:1624 N MCKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2248
Mailing Address - Country:US
Mailing Address - Phone:251-943-3937
Mailing Address - Fax:
Practice Address - Street 1:1624 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2248
Practice Address - Country:US
Practice Address - Phone:251-943-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-58327OtherBLUE CROSS BLUE SHIELD OF
AL0527980002OtherMEDICARE LEGACY INDENTIFIER
AL0527980002Medicare NSC