Basic Information
| Provider Information | |||||||||
| NPI: | 1487635397 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY EYE CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 728 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360810728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3345662020 | ||||||||
| FaxNumber: | 3345662035 | ||||||||
| Practice Location | |||||||||
| Address1: | 606 S GEORGE WALLACE DR | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360813823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3345662020 | ||||||||
| FaxNumber: | 3345662035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 02/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | DUNN | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3345662020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 060156 | AL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | CK 3144 | 01 | AL | RAILROAD MEDICARE | OTHER |