| Name: | Alabama Eye Surgery, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 13 Sep 2004 (20 years ago) |
| Date of dissolution: | 02 Mar 2023 |
| Entity Number: | 000-237-356 |
| Register Number: | 000237356 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 801 PRINCETON AVE SWBIRMINGHAM, AL 35211 |
| Registered Office Street Address ZIP Code: | 35211 |
| Authorized Capital: | $1,000 |
Activities
OPHTHALMOLOGY PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184680647 | 2006-04-25 | 2009-07-17 | PO BOX 10992, BIRMINGHAM, AL, 352020992, US | 801 PRINCETON AVE SW, STE 530, BIRMINGHAM, AL, 352111310, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-787-1411 |
| Fax | 2057872603 |
Authorized person
| Name | BRUCE SHELBY EICH |
| Role | MEDICAL DOCTOR OWNER |
| Phone | 2057871411 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| Is Primary | No |
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529921660 |
| State | AL |
| Issuer | BLUE CROSS OF ALABAMA |
| Number | G042 |
| State | AL |
| Issuer | RAILROAD MEDICARE GROUP |
| Number | DC1578 |
| State | AL |
| Name | Role |
|---|---|
| EICH, BRUCE S | Agent |
| Name | Role |
|---|---|
| OPHTHALMOLOGY ASSOCIATES PC | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
