Provider Demographics
NPI:1821157660
Name:LEEDS FAMILY EYE CARE, INC
Entity Type:Organization
Organization Name:LEEDS FAMILY EYE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:PULLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-281-4983
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:AL
Mailing Address - Zip Code:35094-0010
Mailing Address - Country:US
Mailing Address - Phone:205-702-4380
Mailing Address - Fax:205-702-4381
Practice Address - Street 1:7913 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:AL
Practice Address - Zip Code:35094-2126
Practice Address - Country:US
Practice Address - Phone:205-702-4380
Practice Address - Fax:205-702-4381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSB13TA698152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5812330001Medicare NSC