Provider Demographics
NPI:1912162975
Name:TOMSIK EYECARE, INC
Entity Type:Organization
Organization Name:TOMSIK EYECARE, INC
Other - Org Name:ROBERTA TOMSIK EYECARE ASSOC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-766-2120
Mailing Address - Street 1:2091 FLORENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2751
Mailing Address - Country:US
Mailing Address - Phone:256-766-2120
Mailing Address - Fax:256-766-2796
Practice Address - Street 1:2091 FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2751
Practice Address - Country:US
Practice Address - Phone:256-766-2120
Practice Address - Fax:256-766-2796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS719 TA 177152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51591340OtherBLUE CROSS
AL510G700329Medicare PIN
AL51591340OtherBLUE CROSS