Provider Demographics
NPI:1689768038
Name:EYE CARE ASSOCIATES OF THE SOUTHEAST, P.C.
Entity Type:Organization
Organization Name:EYE CARE ASSOCIATES OF THE SOUTHEAST, P.C.
Other - Org Name:EYE CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HEATH
Authorized Official - Last Name:FEAGIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-794-1175
Mailing Address - Street 1:PO BOX 1846
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-1846
Mailing Address - Country:US
Mailing Address - Phone:334-794-1175
Mailing Address - Fax:334-793-0619
Practice Address - Street 1:111 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301
Practice Address - Country:US
Practice Address - Phone:334-794-1175
Practice Address - Fax:334-793-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-429-TA-034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000059835Medicaid
AL410022118OtherRAILROAD MEDICARE
AL59835OtherBCBS OF ALABAMA
AL59835OtherBCBS OF ALABAMA
AL000059835Medicaid
0455410001Medicare NSC