Provider Demographics
NPI:1174799274
Name:HENAGAR EYE CLINIC INC
Entity type:Organization
Organization Name:HENAGAR EYE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:LILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-657-3453
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:HENAGAR
Mailing Address - State:AL
Mailing Address - Zip Code:35978-0236
Mailing Address - Country:US
Mailing Address - Phone:256-657-3453
Mailing Address - Fax:256-657-3294
Practice Address - Street 1:17154 AL HWY 75
Practice Address - Street 2:
Practice Address - City:HENAGAR
Practice Address - State:AL
Practice Address - Zip Code:35978
Practice Address - Country:US
Practice Address - Phone:256-657-3453
Practice Address - Fax:256-657-3294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
0783250001Medicare NSC