Provider Demographics
NPI:1437659745
Name:DOUBLE OAK MOUNTAIN EYECARE, INC
Entity Type:Organization
Organization Name:DOUBLE OAK MOUNTAIN EYECARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O.D./OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYE
Authorized Official - Middle Name:LEVER
Authorized Official - Last Name:MANSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-533-2274
Mailing Address - Street 1:3429 PELHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2009
Mailing Address - Country:US
Mailing Address - Phone:205-663-3937
Mailing Address - Fax:205-663-6688
Practice Address - Street 1:3429 PELHAM PKWY
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-2009
Practice Address - Country:US
Practice Address - Phone:205-633-3937
Practice Address - Fax:205-633-6688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-869-TA-410152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009934703Medicaid