Healthcare Provider Details

I. General information

NPI: 1003251653
Provider Name (Legal Business Name): FAMILY EYE CARE OF SYLACAUGA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

493 W 3RD ST
SYLACAUGA AL
35150-1916
US

IV. Provider business mailing address

493 W 3RD ST
SYLACAUGA AL
35150-1916
US

V. Phone/Fax

Practice location:
  • Phone: 256-245-7696
  • Fax:
Mailing address:
  • Phone: 256-245-7696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-C54-TA-889
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberS-C54-TA-889
License Number StateAL

VIII. Authorized Official

Name: STACY LEEANN CANTLEY
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 256-507-1416