Healthcare Provider Details

I. General information

NPI: 1285002352
Provider Name (Legal Business Name): FLORENCE EYE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HUGHES RD
MADISON AL
35758-3039
US

IV. Provider business mailing address

21 HUGHES RD
MADISON AL
35758-3039
US

V. Phone/Fax

Practice location:
  • Phone: 256-246-2969
  • Fax: 256-767-7374
Mailing address:
  • Phone: 256-246-2969
  • Fax: 256-767-7374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS722TA009
License Number StateAL

VIII. Authorized Official

Name: HEATHER DAVIS
Title or Position: MANAGER
Credential:
Phone: 256-766-3139