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General NPI Number Information
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NPI Number | 1578811964
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Entity Type | Organization
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Legal Business Name | GENESIS ONE EYE CARE, INC.
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 08/16/2012
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Provider Practice Location Address
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Address Line | 2231 1ST AVE SUITE B
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City | TUSCALOOSA
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State | AL
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Zip | 35401-5008
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Country | US
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Telephone | 205-722-2437
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Fax | 205-331-4653
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Provider Business Mailing Address
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Address Line | PO BOX 70175
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City | TUSCALOOSA
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State | AL
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Zip | 35407-0175
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Country | US
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Telephone | 205-344-2361
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Fax | 205-759-5594
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. COLLEEN DENT
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Credential | O.D.
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Telephone | 205-344-2361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | S477-TA338
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License Number State | AL
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