Provider Demographics
NPI:1508918061
Name:EASTERN MEDICAL EYE CENTER, P.C
Entity Type:Organization
Organization Name:EASTERN MEDICAL EYE CENTER, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-838-3696
Mailing Address - Street 1:52 MEDICAL PARK DR E
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3430
Mailing Address - Country:US
Mailing Address - Phone:205-838-3696
Mailing Address - Fax:
Practice Address - Street 1:150 GILBREATH DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-2827
Practice Address - Country:US
Practice Address - Phone:205-274-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529703870Medicaid
AL0669280002Medicare NSC
AL529703870Medicaid
ALCB6310Medicare ID - Type UnspecifiedTRAVELERS