East Limestone Eye Care, P.C.
Organization Active NPI Optometrist · Harvest, AL
NPI 1104120823 · NPPES record last updated May 8, 2023
Key facts
- NPI
- 1104120823
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- S-C33-TA-855 (AL)
- Legal business name
- EAST LIMESTONE EYE CARE, P.C.
- Practice address
- 15123 E Limestone Rd
Harvest, AL 35749-7221 - Phone
- (256) 230-9637
- Fax
- (256) 230-0143
- NPI assigned
- Jan 10, 2011
- Organization subpart
- No
Authorized official
- Name
- Dr. Heather Moon Small, O.D.
- Title
- President
- Phone
- (256) 614-9043
Practitioners 3
-
Heather Moon Small, O.D.
-
Melissa Doucette, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120501000219 | AL | Part B Supplier - Clinic/Group Practice | 9739341199 |
Receives reassigned benefits from 2 practitioners Practice locations: Athens, AL |
National Provider Directory
Locations
15123 E Limestone Rd
Harvest, AL 35749
Phone (256) 230-9637
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | S-C33-TA-855 | AL | Yes |
Addresses
Primary practice location
15123 E Limestone Rd
Harvest, AL 35749-7221
Mailing address
PO Box 178
Capshaw, AL 35742-0178
Phone (256) 230-9637
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 126155 | Medicaid | AL |
Other providers in Harvest, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.