| Name: | Primary EyeCare Center LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 13 Apr 2011 (14 years ago) |
| Entity Number: | 000-009-003 |
| Register Number: | 000009003 |
| County: | Dallas |
| Place of Formation: | Dallas County |
| Principal Address: | 801 DALLAS AVESELMA, AL 36701 |
| Principal Address ZIP Code: | 36701 |
| Registered Office Street Address: | 801 DALLAS AVENUESELMA, AL 36701 |
| Registered Office Street Address ZIP Code: | 36701 |
Activities
OPTOMETRY PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427349406 | 2011-04-26 | 2024-04-22 | 2401 MEDICAL CENTER PKWY., SELMA, AL, 367017756, US | 2401 MEDICAL CENTER PKWY., SELMA, AL, 367017756, US | |||||||||||||||||||||||||
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| Phone | +1 334-874-7024 |
| Fax | 3348747372 |
Authorized person
| Name | DR. KRISTINA LOVINGGOOD |
| Role | AUTHORIZED OFFICIAL/PRESIDENT/OD |
| Phone | 3348747024 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | SC32TA854 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 128417 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| LOVINGGOOD, KRISTINA | Agent | 209 PINE NEEDLE DRIVESELMA, AL 36701 |
| Name | Role | Address |
|---|---|---|
| LOVINGGOOD, KRISTINA | Organizer | 209 PINE NEEDLE DRIVESELMA, AL 36701 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
