Healthcare Provider Details

I. General information

NPI: 1356409080
Provider Name (Legal Business Name): ST CLAIR EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6448 US HIGHWAY 11
SPRINGVILLE AL
35146-4010
US

IV. Provider business mailing address

6448 US HIGHWAY 11
SPRINGVILLE AL
35146-4010
US

V. Phone/Fax

Practice location:
  • Phone: 205-467-7608
  • Fax: 205-467-2120
Mailing address:
  • Phone: 205-467-7608
  • Fax: 205-467-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS970TA531
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS951TA530
License Number StateAL

VIII. Authorized Official

Name: DR. SHELLEIGH MCVICKER BUCKINGHAM II
Title or Position: VICE PRESIDENT
Credential: O.D.
Phone: 205-467-7608