MEDICARE: EYECARE ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	S453TA283	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1053466821	OTHER	AL	GROUP NPI
2	1851373385	OTHER	AL	INDIVIDUAL NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053466821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYECARE ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 207243
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-7255
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	636-527-0766

Provider Business Practice Location Address
First Line	:	7419 HWY 431 N COLLINS PLAZA
Second Line	:
City	:	ALBERTVILLE
State	:	AL
Zip	:	35950-1194
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	256-878-0939

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. MICHAEL J CARBONI
Credential	:	OD
Telephone Number	:	256-878-0125

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/09/2024

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Directions to “EYECARE ASSOCIATES, INC. ” Practice Location

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