Provider Demographics
NPI:1871810614
Name:THE EYE CENTER OF ALABAMA, PC
Entity type:Organization
Organization Name:THE EYE CENTER OF ALABAMA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-221-4705
Mailing Address - Street 1:20 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3425
Mailing Address - Country:US
Mailing Address - Phone:205-221-4705
Mailing Address - Fax:205-221-6653
Practice Address - Street 1:20 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3425
Practice Address - Country:US
Practice Address - Phone:205-221-4705
Practice Address - Fax:205-221-6653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28293207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1780887182Medicaid
AL28293OtherMEDICAL LICENSE