=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457753055
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYECARE ASSOCIATES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2014
-----------------------------------------------------
Last Update Date | 07/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9821 OLD HIGHWAY 31
-----------------------------------------------------
City | WARRIOR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-200-4393
-----------------------------------------------------
Fax | 205-647-3934
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 207243
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75320-7243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-200-4393
-----------------------------------------------------
Fax | 636-527-0766
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CMO
-----------------------------------------------------
Name | JAMES WACHTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 636-200-4393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | S721TA181
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------