Provider Demographics
NPI:1902005192
Name:SCHAEFFER EYE CENTER INC
Entity Type:Organization
Organization Name:SCHAEFFER EYE CENTER INC
Other - Org Name:SCHAEFFER EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-661-2080
Mailing Address - Street 1:PO BOX 1310
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-6102
Mailing Address - Country:US
Mailing Address - Phone:205-661-2080
Mailing Address - Fax:205-661-2085
Practice Address - Street 1:2550 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-1500
Practice Address - Country:US
Practice Address - Phone:334-274-2020
Practice Address - Fax:334-396-9924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0676180014Medicare NSC