Provider Demographics
NPI:1104120823
Name:EAST LIMESTONE EYE CARE, P.C.
Entity type:Organization
Organization Name:EAST LIMESTONE EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MOON
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-614-9043
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:CAPSHAW
Mailing Address - State:AL
Mailing Address - Zip Code:35742-0178
Mailing Address - Country:US
Mailing Address - Phone:256-230-9637
Mailing Address - Fax:256-230-0143
Practice Address - Street 1:15123 E LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749-7221
Practice Address - Country:US
Practice Address - Phone:256-230-9637
Practice Address - Fax:256-230-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-C33-TA-855152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL126155Medicaid
AL126155Medicaid