Provider Demographics
NPI:1649763525
Name:STPETER EYE CARE, LLC
Entity Type:Organization
Organization Name:STPETER EYE CARE, LLC
Other - Org Name:STPETER EYE CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. PETER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-509-1872
Mailing Address - Street 1:215 POINTE VERDE CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3615
Mailing Address - Country:US
Mailing Address - Phone:256-509-1872
Mailing Address - Fax:
Practice Address - Street 1:517 AVALON AVE
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2811
Practice Address - Country:US
Practice Address - Phone:256-381-7969
Practice Address - Fax:256-381-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-C51-TA-902152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty