Provider Demographics
NPI:1871717199
Name:RAINBOW CITY FAMILY EYE CARE LLC
Entity type:Organization
Organization Name:RAINBOW CITY FAMILY EYE CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-625-3937
Mailing Address - Street 1:2040 2ND AVE E
Mailing Address - Street 2:SUITE B
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-2731
Mailing Address - Country:US
Mailing Address - Phone:205-625-3937
Mailing Address - Fax:205-466-7155
Practice Address - Street 1:2040 2ND AVE E
Practice Address - Street 2:SUITE B
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-2731
Practice Address - Country:US
Practice Address - Phone:205-625-3937
Practice Address - Fax:205-625-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL302152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009963650Medicaid
AL51504016OtherBLUE CROSS BLUE SHIELD
ALU20353Medicare UPIN
AL1285930002Medicare NSC
AL51504016OtherBLUE CROSS BLUE SHIELD