Basic Information
| Provider Information | |||||||||
| NPI: | 1225449234 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SCHAEFFER EYE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1310 | ||||||||
| Address2: | |||||||||
| City: | TRUSSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351736102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056612080 | ||||||||
| FaxNumber: | 2056612085 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 CAHABA RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MOUNTAIN BRK | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352231169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058703937 | ||||||||
| FaxNumber: | 2058703932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2014 | ||||||||
| LastUpdateDate: | 05/13/2014 | ||||||||
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| AuthorizedOfficialLastName: | SCHAEFFER | ||||||||
| AuthorizedOfficialFirstName: | JACK | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2056612080 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | S400TA921 | AL | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.