Provider Demographics
NPI:1558403568
Name:JEMISON EYE CARE LLC
Entity Type:Organization
Organization Name:JEMISON EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF BOARD OF DIRECTORS
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-688-1010
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:JEMISON
Mailing Address - State:AL
Mailing Address - Zip Code:35085-0730
Mailing Address - Country:US
Mailing Address - Phone:205-688-1010
Mailing Address - Fax:
Practice Address - Street 1:24810 US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:JEMISON
Practice Address - State:AL
Practice Address - Zip Code:35085-7876
Practice Address - Country:US
Practice Address - Phone:205-688-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-A35-TA-588152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510G700150OtherMEDICARE PTAN
AL529912640Medicaid
AL529912640Medicaid
ALDT1832Medicare PIN