Healthcare Provider Details

I. General information

NPI: 1023745478
Provider Name (Legal Business Name): EYECARE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3429 PELHAM PKWY
PELHAM AL
35124-2009
US

IV. Provider business mailing address

PO BOX 207243
DALLAS TX
75320-7243
US

V. Phone/Fax

Practice location:
  • Phone: 205-663-3937
  • Fax:
Mailing address:
  • Phone: 636-200-4393
  • Fax: 636-527-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES WACHTER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 636-200-4393