MEDICARE: EYE ASSOCIATES PC

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	S615TA099	AL
2	207W00000X	Ophthalmology Physician	16404	AL

General Provider Information

NPI Number	:	1538268685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE ASSOCIATES PC

Provider Business Mailing Address
First Line	:	3368 HIGHWAY 280
Second Line	:	SUITE 215
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-3393
Country	:	US
Telephone Number	:	256-329-9064
Fax Number	:	256-329-0262

Provider Business Practice Location Address
First Line	:	3368 HIGHWAY 280
Second Line	:	SUITE 215
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-3393
Country	:	US
Telephone Number	:	256-329-9064
Fax Number	:	256-329-0262

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK TUCKER
Credential	:	M.D.
Telephone Number	:	256-329-9064

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	10/18/2007

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Directions to “EYE ASSOCIATES PC ” Practice Location

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