Healthcare Provider Details

I. General information

NPI: 1356146013
Provider Name (Legal Business Name): LEGACY EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140A UNIVERSITY DR NW
HUNTSVILLE AL
35806-1710
US

IV. Provider business mailing address

231 BRIGHTON PARK WAY
MADISON AL
35756-4931
US

V. Phone/Fax

Practice location:
  • Phone: 256-837-5642
  • Fax: 256-803-2384
Mailing address:
  • Phone: 205-370-9430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LATISHA MARBUARY
Title or Position: OWNER
Credential: OD
Phone: 205-370-9430