Healthcare Provider Details

I. General information

NPI: 1417072844
Provider Name (Legal Business Name): EYECARE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BOB WALLACE AVE SW
HUNTSVILLE AL
35801-3809
US

IV. Provider business mailing address

PO BOX 207243
DALLAS TX
75320-7255
US

V. Phone/Fax

Practice location:
  • Phone: 636-200-4393
  • Fax: 256-539-3478
Mailing address:
  • Phone: 636-200-4393
  • Fax: 636-527-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberS384TA085
License Number StateAL

VIII. Authorized Official

Name: DR. WILLIAM S SULLINS
Title or Position: DOCTOR
Credential: OD
Phone: 256-539-3454