Organization
JEMISON EYE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA R GREEN O.D. (CHAIRMAN OF BOARD OF DIRECTORS)
(205) 688-1010
Entity
Organization
Contact information
Practice address
24810 US HIGHWAY 31, JEMISON, AL 35085-7876
(205) 688-1010
Mailing address
PO BOX 730, JEMISON, AL 35085-0730
(205) 688-1010
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-A35-TA-588
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
510G700150
MEDICARE PTAN
AL
05
—
529912640
—
AL
Enumeration date
02/13/2007
Last updated
06/03/2014
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