Healthcare Provider Details

I. General information

NPI: 1104120823
Provider Name (Legal Business Name): EAST LIMESTONE EYE CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15123 E LIMESTONE RD
HARVEST AL
35749-7221
US

IV. Provider business mailing address

PO BOX 178
CAPSHAW AL
35742-0178
US

V. Phone/Fax

Practice location:
  • Phone: 256-230-9637
  • Fax: 256-230-0143
Mailing address:
  • Phone: 256-230-9637
  • Fax: 256-230-0143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-C33-TA-855
License Number StateAL

VIII. Authorized Official

Name: DR. HEATHER MOON SMALL
Title or Position: PRESIDENT
Credential: O.D.
Phone: 256-614-9043