Healthcare Provider Details

I. General information

NPI: 1174195341
Provider Name (Legal Business Name): EYE SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 HIGHLAND AVE S STE 350
BIRMINGHAM AL
35205-4009
US

IV. Provider business mailing address

2101 HIGHLAND AVE S STE 350
BIRMINGHAM AL
35205-4009
US

V. Phone/Fax

Practice location:
  • Phone: 205-558-2525
  • Fax: 205-558-2554
Mailing address:
  • Phone: 205-558-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDGAR READY IV
Title or Position: MEMBER
Credential: MD
Phone: 205-558-2525