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	S879TA440	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891862942
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	:	75320-7243
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	256-442-6292

Provider Business Practice Location Address
First Line	:	1755 HIGHWAY 77
Second Line	:
City	:	SOUTHSIDE
State	:	AL
Zip	:	35907-0169
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	256-442-6292

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES WACHTER
Credential	:
Telephone Number	:	636-200-4393

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/09/2024

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Directions to “EYECARE ASSOCIATES, INC. ” Practice Location

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