Provider Demographics
NPI:1356409080
Name:ST CLAIR EYE CARE LLC
Entity type:Organization
Organization Name:ST CLAIR EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEIGH
Authorized Official - Middle Name:MCVICKER
Authorized Official - Last Name:BUCKINGHAM
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:205-467-7608
Mailing Address - Street 1:6448 US HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35146-4010
Mailing Address - Country:US
Mailing Address - Phone:205-467-7608
Mailing Address - Fax:205-467-2120
Practice Address - Street 1:6448 US HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:AL
Practice Address - Zip Code:35146-4010
Practice Address - Country:US
Practice Address - Phone:205-467-7608
Practice Address - Fax:205-467-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS970TA531152W00000X
ALS951TA530152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty