Provider Demographics
NPI:1740350842
Name:EYECARE PROFESSIONALS, P.C.
Entity type:Organization
Organization Name:EYECARE PROFESSIONALS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-332-5440
Mailing Address - Street 1:PO BOX 1177
Mailing Address - Street 2:15255 HWY 43 NORTH, SUITE 1
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-1177
Mailing Address - Country:US
Mailing Address - Phone:256-332-5440
Mailing Address - Fax:256-332-5402
Practice Address - Street 1:15255 HIGHWAY 43
Practice Address - Street 2:SUITE 1
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1924
Practice Address - Country:US
Practice Address - Phone:256-332-5440
Practice Address - Fax:256-332-5402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000059359Medicaid
AL009980355Medicaid
AL0000059364Medicaid
AL529900990Medicaid
ALU90328Medicare UPIN
AL051526031Medicare ID - Type Unspecified
AL000059359Medicaid
AL000059364Medicare ID - Type Unspecified
AL000059359Medicare ID - Type Unspecified
AL0000059364Medicaid
AL009980355Medicaid
ALD960Medicare PIN