Provider Demographics
NPI:1770755126
Name:BIRMINGHAM EYE CENTER
Entity type:Organization
Organization Name:BIRMINGHAM EYE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-979-4730
Mailing Address - Street 1:840 MONTCLAIR RD
Mailing Address - Street 2:SUITE 408
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1920
Mailing Address - Country:US
Mailing Address - Phone:205-592-5130
Mailing Address - Fax:
Practice Address - Street 1:860 MONTCLAIR RD
Practice Address - Street 2:SUITE 450
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1923
Practice Address - Country:US
Practice Address - Phone:205-595-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIRMINGHAM EYE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17074332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALD83820Medicare UPIN