Provider Demographics
NPI:1932314473
Name:FLORENCE OPHTHALMOLOGY PC
Entity Type:Organization
Organization Name:FLORENCE OPHTHALMOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-760-1771
Mailing Address - Street 1:646 COX CREEK PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1105
Mailing Address - Country:US
Mailing Address - Phone:256-760-9149
Mailing Address - Fax:256-760-9149
Practice Address - Street 1:646 COX CREEK PKWY STE A
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1189
Practice Address - Country:US
Practice Address - Phone:256-760-1771
Practice Address - Fax:256-766-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI964Medicare ID - Type Unspecified