Basic Information
Provider Information | |||||||||
NPI: | 1922207182 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SCHAEFFER EYE CENTER INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SCHAEFFER EYE CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1310 | ||||||||
Address2: |   | ||||||||
City: | TRUSSVILLE | ||||||||
State: | AL | ||||||||
PostalCode: | 351736102 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2056612080 | ||||||||
FaxNumber: | 2056612085 | ||||||||
Practice Location | |||||||||
Address1: | 2737 HIGHWAY 280 S | ||||||||
Address2: | SUITE 191 | ||||||||
City: | MT. BROOK | ||||||||
State: | AL | ||||||||
PostalCode: | 352232466 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2058022020 | ||||||||
FaxNumber: | 2058030078 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/17/2007 | ||||||||
LastUpdateDate: | 04/27/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SMITH | ||||||||
AuthorizedOfficialFirstName: | PENNY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
AuthorizedOfficialTelephone: | 2056612080 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X |   |   | Y |   | Suppliers | Eyewear Supplier (Equipment, not the service) |   |
No ID Information.