Provider Demographics
NPI:1578811964
Name:GENESIS ONE EYE CARE, INC.
Entity Type:Organization
Organization Name:GENESIS ONE EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DENT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-344-2361
Mailing Address - Street 1:PO BOX 70175
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35407-0175
Mailing Address - Country:US
Mailing Address - Phone:205-344-2361
Mailing Address - Fax:205-759-5594
Practice Address - Street 1:2231 1ST AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-5008
Practice Address - Country:US
Practice Address - Phone:205-722-2437
Practice Address - Fax:205-331-4653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS477-TA338261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center