Healthcare Provider Details

I. General information

NPI: 1174799274
Provider Name (Legal Business Name): HENAGAR EYE CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17154 AL HWY 75
HENAGAR AL
35978
US

IV. Provider business mailing address

PO BOX 236
HENAGAR AL
35978-0236
US

V. Phone/Fax

Practice location:
  • Phone: 256-657-3453
  • Fax: 256-657-3294
Mailing address:
  • Phone: 256-657-3453
  • Fax: 256-657-3294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARON KAYE LILES
Title or Position: PRESIDENT
Credential:
Phone: 256-657-3453