Provider Demographics
NPI:1316950736
Name:MEDICAL ARTS EYE CLINIC PC
Entity type:Organization
Organization Name:MEDICAL ARTS EYE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-749-1486
Mailing Address - Street 1:122 N 20TH ST
Mailing Address - Street 2:BLDG 26
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801
Mailing Address - Country:US
Mailing Address - Phone:334-749-1486
Mailing Address - Fax:334-749-1748
Practice Address - Street 1:122 N 20TH ST
Practice Address - Street 2:BLDG 26
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801
Practice Address - Country:US
Practice Address - Phone:334-749-1486
Practice Address - Fax:334-749-1748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty