Provider Demographics
NPI:1841347267
Name:ADVENT EYE CARE CENTER, LLC
Entity type:Organization
Organization Name:ADVENT EYE CARE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRANTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-937-1213
Mailing Address - Street 1:700 BOULEVARD SOUTH SW
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2115
Mailing Address - Country:US
Mailing Address - Phone:256-937-1213
Mailing Address - Fax:
Practice Address - Street 1:700 BOULEVARD SOUTH SW
Practice Address - Street 2:SUITE 104
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2115
Practice Address - Country:US
Practice Address - Phone:256-937-1213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR-214152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty