Provider Demographics
NPI:1881781268
Name:ATHENS EYE CARE CENTER, P.C.
Entity type:Organization
Organization Name:ATHENS EYE CARE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:L.
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-232-2409
Mailing Address - Street 1:22984 US HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613
Mailing Address - Country:US
Mailing Address - Phone:256-232-2409
Mailing Address - Fax:256-232-2402
Practice Address - Street 1:22984 US HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613
Practice Address - Country:US
Practice Address - Phone:256-232-2409
Practice Address - Fax:256-232-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS889TA445152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529914941Medicaid
AL4835600001Medicare NSC