Provider Demographics
NPI:1619923745
Name:EYE HEALTH PARTNERS OF ALABAMA INC
Entity Type:Organization
Organization Name:EYE HEALTH PARTNERS OF ALABAMA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:C
Authorized Official - Last Name:CADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-943-4604
Mailing Address - Street 1:200 WILDWOOD PKWY STE 100B
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7300
Mailing Address - Country:US
Mailing Address - Phone:205-943-4600
Mailing Address - Fax:256-459-7963
Practice Address - Street 1:250 STATE FARM PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-7181
Practice Address - Country:US
Practice Address - Phone:205-943-4600
Practice Address - Fax:205-943-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCA7622OtherRAILROAD MEDICARE
J878Medicare ID - Type Unspecified
AL529910020Medicaid
AL1619923745Medicaid
AL1619923745Medicare PIN
I779Medicare ID - Type UnspecifiedGADSDEN
ALI778Medicare ID - Type Unspecified
ALJ334Medicare ID - Type UnspecifiedHUNTSVILLE