Provider Demographics
NPI:1437486107
Name:CALERA VISION CENTER, LLC
Entity Type:Organization
Organization Name:CALERA VISION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:O,D,
Authorized Official - Phone:205-585-6461
Mailing Address - Street 1:300 AIRPORT COMMONS DRIVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040
Mailing Address - Country:US
Mailing Address - Phone:205-621-6061
Mailing Address - Fax:205-621-6064
Practice Address - Street 1:300 AIRPORT COMMONS DRIVE
Practice Address - Street 2:SUITE 304
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040-0001
Practice Address - Country:US
Practice Address - Phone:205-621-6061
Practice Address - Fax:205-621-6064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-779-TA-718152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty