| Name: | Eyecare For Life, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 14 Feb 2007 (18 years ago) |
| Date of dissolution: | 08 Sep 2020 |
| Entity Number: | 000-251-167 |
| Register Number: | 000251167 |
| County: | Franklin |
| Place of Formation: | Franklin County |
| Principal Address: | RUSSELLVILLE, AL |
| Registered Office Street Address: | 15255 HWY 43RUSSELLVILLE, AL 35653 |
| Registered Office Street Address ZIP Code: | 35653 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
EYE CARE SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659449015 | 2006-12-01 | 2022-07-21 | 15255 HWY 43, 2ND FL, RUSSELLVILLE, AL, 356531925, US | 15255 HIGHWAY 43, 2ND FL, RUSSELLVILLE, AL, 356531924, US | |||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 256-332-5440 |
| Fax | 2563325403 |
Authorized person
| Name | DR. STUART M GREENBERG |
| Role | PRESIDENT/OWNER/PHYSICIAN |
| Phone | 2563325440 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 07608091 |
| State | MS |
| Issuer | MEDICAID |
| Number | 529932110 |
| State | AL |
| Issuer | MEDICAID |
| Number | 894967095A |
| State | GA |
| Issuer | MEDICAID |
| Number | 1505923 |
| State | TN |
| Name | Role |
|---|---|
| GREENBERG, MARTHA R | Agent |
| Name | Role |
|---|---|
| GREENBERG, MARTHA R | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
