Provider Demographics
NPI:1861663312
Name:ELITE EYECARE ASSOCIATES, PC
Entity Type:Organization
Organization Name:ELITE EYECARE ASSOCIATES, PC
Other - Org Name:GARY W. MURRELL, O.D., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INS. BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-236-7516
Mailing Address - Street 1:425 E 10TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4787
Mailing Address - Country:US
Mailing Address - Phone:256-236-7516
Mailing Address - Fax:256-237-6730
Practice Address - Street 1:425 E 10TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4787
Practice Address - Country:US
Practice Address - Phone:256-236-7516
Practice Address - Fax:256-237-6730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS514TA101152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000059777Medicaid
AL000059777Medicaid
AL0573680001Medicare NSC