Provider Demographics
NPI:1730281882
Name:GADSDEN EYE ASSOCIATES P C
Entity Type:Organization
Organization Name:GADSDEN EYE ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF REVENUE CYCLE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-990-7590
Mailing Address - Street 1:PO BOX 8567
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-8567
Mailing Address - Country:US
Mailing Address - Phone:256-547-8634
Mailing Address - Fax:256-547-3039
Practice Address - Street 1:310 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4224
Practice Address - Country:US
Practice Address - Phone:256-547-8634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000158333174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529101930Medicaid