Provider Demographics
NPI:1538371075
Name:EYEDOCS ON WHEELS PC
Entity type:Organization
Organization Name:EYEDOCS ON WHEELS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-332-5440
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653
Mailing Address - Country:US
Mailing Address - Phone:256-332-5440
Mailing Address - Fax:256-332-5402
Practice Address - Street 1:15255 HWY 43
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653
Practice Address - Country:US
Practice Address - Phone:256-332-5440
Practice Address - Fax:256-332-5402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALOPT002359OtherSTATE LICENSE NUMBER