Provider Demographics
NPI:1659449015
Name:EYECARE FOR LIFE, PC
Entity Type:Organization
Organization Name:EYECARE FOR LIFE, PC
Other - Org Name:EYECARE FOR LIFE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-332-5440
Mailing Address - Street 1:15255 HWY 43
Mailing Address - Street 2:2ND FL
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-1925
Mailing Address - Country:US
Mailing Address - Phone:256-332-5440
Mailing Address - Fax:256-332-5403
Practice Address - Street 1:15255 HIGHWAY 43
Practice Address - Street 2:2ND FL
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1924
Practice Address - Country:US
Practice Address - Phone:256-332-5440
Practice Address - Fax:256-332-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07608091Medicaid
AL529932110Medicaid
GA894967095AMedicaid
TN1505923Medicaid
MS07608091Medicaid
GA894967095AMedicaid
ALL154Medicare PIN
TN1505923Medicaid
GA511G700939Medicare PIN