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General NPI Number Information
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NPI Number | 1104172642
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Entity Type | Organization
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Legal Business Name | THE EYE SITE, P.C.
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 504 S MULBERRY AVE
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City | BUTLER
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State | AL
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Zip | 36904-2804
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Country | US
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Telephone | 205-459-7483
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Fax |
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Provider Business Mailing Address
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Address Line | 504 S MULBERRY AVE
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City | BUTLER
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State | AL
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Zip | 36904-2804
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Country | US
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Telephone | 205-459-7483
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHANIE OMMEN
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Credential | OD
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Telephone | 205-459-7483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | S-C87
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License Number State | AL
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