Healthcare Provider Details

I. General information

NPI: 1336257575
Provider Name (Legal Business Name): POARCH BAND OF CREEK INDIANS DBA PREMIER FAMILY EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5811 JACK SPRINGS RD
ATMORE AL
36502-5025
US

IV. Provider business mailing address

5811 JACK SPRINGS RD.
ATMORE AL
36502
US

V. Phone/Fax

Practice location:
  • Phone: 251-446-3937
  • Fax: 251-368-0805
Mailing address:
  • Phone: 251-446-3937
  • Fax: 251-368-0805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MS. EDDIE JACKSON
Title or Position: HEALTH ADMINISTRATOR
Credential:
Phone: 251-368-9136