Provider Demographics
NPI:1134717572
Name:DRY EYE CENTER OF ALABAMA, LLC
Entity type:Organization
Organization Name:DRY EYE CENTER OF ALABAMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICING OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DERRICK
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-490-2322
Mailing Address - Street 1:3490 INDEPENDENCE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5604
Mailing Address - Country:US
Mailing Address - Phone:205-490-2322
Mailing Address - Fax:205-510-9469
Practice Address - Street 1:3490 INDEPENDENCE DR STE 110
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5604
Practice Address - Country:US
Practice Address - Phone:205-490-2322
Practice Address - Fax:205-510-9469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL216124Medicaid