Provider Demographics
NPI:1053568758
Name:SOUTH ALABAMA EYE CARE, P.C.
Entity type:Organization
Organization Name:SOUTH ALABAMA EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:FRAZIER
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-774-4703
Mailing Address - Street 1:100 FRANKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36350-6034
Mailing Address - Country:US
Mailing Address - Phone:334-873-4247
Mailing Address - Fax:
Practice Address - Street 1:1892 ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-3724
Practice Address - Country:US
Practice Address - Phone:334-774-4703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-B17-TA-702152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty