Provider Demographics
NPI:1457479180
Name:EYE FOUNDATION OPTICAL SHOPPE
Entity Type:Organization
Organization Name:EYE FOUNDATION OPTICAL SHOPPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SADLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-325-8596
Mailing Address - Street 1:1720 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1816
Mailing Address - Country:US
Mailing Address - Phone:205-325-8227
Mailing Address - Fax:
Practice Address - Street 1:1720 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1816
Practice Address - Country:US
Practice Address - Phone:205-325-8227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UAB CALLAHAN EYE HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009800540Medicaid