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General NPI Number Information
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NPI Number | 1053478701
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Entity Type | Organization
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Legal Business Name | EUFAULA EYE ASSOCIATES, INC.
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 138 E BROAD ST
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City | EUFAULA
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State | AL
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Zip | 36027-2024
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Country | US
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Telephone | 334-687-2545
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Fax | 334-687-6491
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Provider Business Mailing Address
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Address Line | PO BOX 635
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City | EUFAULA
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State | AL
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Zip | 36072-0635
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Country | US
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Telephone | 334-687-2545
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Fax | 334-687-6491
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Authorized Official
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Title or Position | OWNER
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Name | DR. HERNAN BENAVIDES
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Credential | O.D.
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Telephone | 334-687-2545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | S387TA013
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License Number State | AL
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