Provider Demographics
NPI:1538268685
Name:EYE ASSOCIATES PC
Entity type:Organization
Organization Name:EYE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-329-9064
Mailing Address - Street 1:3368 HIGHWAY 280
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3393
Mailing Address - Country:US
Mailing Address - Phone:256-329-9064
Mailing Address - Fax:256-329-0262
Practice Address - Street 1:3368 HIGHWAY 280
Practice Address - Street 2:SUITE 215
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3393
Practice Address - Country:US
Practice Address - Phone:256-329-9064
Practice Address - Fax:256-329-0262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS615TA099152W00000X
AL16404207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE474Medicare PIN
ALB64602Medicare UPIN
ALI101Medicare PIN
ALT69014Medicare UPIN
ALD426Medicare PIN