Provider Demographics
NPI:1619044948
Name:CARGUS EYECARE INC
Entity Type:Organization
Organization Name:CARGUS EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARGUS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-477-0229
Mailing Address - Street 1:4760 EASTERN VALLEY RD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:MC CALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35111-3456
Mailing Address - Country:US
Mailing Address - Phone:205-477-0229
Mailing Address - Fax:
Practice Address - Street 1:4760 EASTERN VALLEY RD
Practice Address - Street 2:SUITE 132
Practice Address - City:MC CALLA
Practice Address - State:AL
Practice Address - Zip Code:35111-3456
Practice Address - Country:US
Practice Address - Phone:205-477-0229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS882TA441152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510G700282Medicare PIN
ALU74218Medicare UPIN