Provider Demographics
NPI:1619249836
Name:EAST ALABAMA EYE ASSOCIATES,INC.
Entity Type:Organization
Organization Name:EAST ALABAMA EYE ASSOCIATES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-821-3700
Mailing Address - Street 1:923 STAGE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5109
Mailing Address - Country:US
Mailing Address - Phone:334-821-3700
Mailing Address - Fax:334-821-3776
Practice Address - Street 1:923 STAGE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-5112
Practice Address - Country:US
Practice Address - Phone:334-821-3700
Practice Address - Fax:334-821-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-556-TA-036152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102G702777Medicare PIN