Healthcare Provider Details

I. General information

NPI: 1710012877
Provider Name (Legal Business Name): EYECARE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 GREEN VALLEY RD
BIRMINGHAM AL
35243-5262
US

IV. Provider business mailing address

PO BOX 207243
DALLAS TX
75320-7255
US

V. Phone/Fax

Practice location:
  • Phone: 636-200-4393
  • Fax: 205-967-2119
Mailing address:
  • Phone: 636-200-4393
  • Fax: 636-527-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS462TA018
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberSB75TA798
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberSB75TA798
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberS462TA018
License Number StateAL

VIII. Authorized Official

Name: CHARLES K BROWN
Title or Position: DOCTOR
Credential: OD
Phone: 205-967-2103