Andalusia Eye Clinic LLC
Organization Active NPI Optometrist · Andalusia, AL
NPI 1629133111 · NPPES record last updated Aug 17, 2015
Key facts
- NPI
- 1629133111
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- S620TA088 (AL)
- Legal business name
- ANDALUSIA EYE CLINIC LLC
- Practice address
- 1860 E Three Notch St
Andalusia, AL 36421-2404 - Phone
- (334) 222-2020
- NPI assigned
- Dec 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. James H Tillman Jr., OD
- Title
- Owner
- Phone
- (334) 222-2020
Practitioners 5
-
Aaron B McKinley, MD
-
James H Tillman Jr., O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051006000899 | AL | Part B Supplier - Clinic/Group Practice | 1557386778 |
Receives reassigned benefits from 4 practitioners Practice locations: Andalusia, AL |
National Provider Directory
Locations
1860 E Three Notch St
Andalusia, AL 36421
Phone (334) 222-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | S620TA088 | AL | Yes |
| Ophthalmology Physician |
207W00000X | 00025149 | AL |
Addresses
Primary practice location
1860 E Three Notch St
Andalusia, AL 36421-2404
Mailing address
PO Box 1517
Andalusia, AL 36420-1226
Phone (334) 222-2020
Other providers in Andalusia, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2015. 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.