Provider Demographics
NPI:1629680830
Name:MOBILE MEDICAL EYE CARE LLC
Entity Type:Organization
Organization Name:MOBILE MEDICAL EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:469-660-4503
Mailing Address - Street 1:12910 SHELBYVILLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2404
Mailing Address - Country:US
Mailing Address - Phone:502-244-2420
Mailing Address - Fax:502-996-8282
Practice Address - Street 1:110 MOSELEY CROSSING DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6501
Practice Address - Country:US
Practice Address - Phone:502-244-2420
Practice Address - Fax:502-996-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty