Provider Demographics
NPI:1528166469
Name:NORTHEAST ALABAMA EYECARE ASSOCIATES LLC
Entity type:Organization
Organization Name:NORTHEAST ALABAMA EYECARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TREASURE
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:PHARR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-538-9903
Mailing Address - Street 1:522 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-4232
Mailing Address - Country:US
Mailing Address - Phone:256-547-5709
Mailing Address - Fax:256-547-5700
Practice Address - Street 1:522 WALNUT ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4232
Practice Address - Country:US
Practice Address - Phone:256-547-5709
Practice Address - Fax:256-547-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS489-TA-125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0306690001OtherPALMETTO GBA
ALDD1099OtherRAILROAD MEDICARE
ALG386Medicare ID - Type UnspecifiedMEDICARE NUMBER