Provider Demographics
NPI:1992038335
Name:EYE DOCTORS OFFICE, INC
Entity Type:Organization
Organization Name:EYE DOCTORS OFFICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:ROTEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-794-0585
Mailing Address - Street 1:1936 ROSS CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-5750
Mailing Address - Country:US
Mailing Address - Phone:334-794-0585
Mailing Address - Fax:334-671-4943
Practice Address - Street 1:1936 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-5750
Practice Address - Country:US
Practice Address - Phone:334-794-0585
Practice Address - Fax:334-671-4943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS313-TA-244152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4820060001Medicare NSC