Provider Demographics
NPI:1548434657
Name:BIBB COUNTY EYE CARE
Entity type:Organization
Organization Name:BIBB COUNTY EYE CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-926-4816
Mailing Address - Street 1:223 PIERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35042-2919
Mailing Address - Country:US
Mailing Address - Phone:205-926-4816
Mailing Address - Fax:888-803-4916
Practice Address - Street 1:223 PIERSON AVE
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:AL
Practice Address - Zip Code:35042-2919
Practice Address - Country:US
Practice Address - Phone:205-926-4816
Practice Address - Fax:888-803-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-374-TA-005332H00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000059437Medicaid
ALS-374-TA-005OtherAL LICENSE
AL406183603OtherRRTRAV
ALS-374-TA-005OtherAL LICENSE
ALS-374-TA-005OtherAL LICENSE
AL0242750001Medicare NSC