Provider Demographics
NPI:1447033634
Name:AZALEA EYE CLINICS LLC
Entity type:Organization
Organization Name:AZALEA EYE CLINICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:ROLWING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-683-0435
Mailing Address - Street 1:222 E COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63834-1749
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 E COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MO
Practice Address - Zip Code:63834-1749
Practice Address - Country:US
Practice Address - Phone:573-233-8168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty