| Name: | Fountain City Eyecare, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 15 Apr 2002 (23 years ago) |
| Date of dissolution: | 24 Apr 2018 |
| Entity Number: | 000-681-944 |
| Register Number: | 000681944 |
| County: | Autauga |
| Place of Formation: | Autauga County |
| Principal Address: | PRATTVILLE, AL |
| Registered Office Street Address: | 1807 STATION DR STE DPRATTVILLE, AL 36066 |
| Registered Office Street Address ZIP Code: | 36066 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245390459 | 2006-12-11 | 2010-05-25 | 1807 STATION DR, SUITE A, PRATTVILLE, AL, 360665664, US | 1807 STATION DR, SUITE A, PRATTVILLE, AL, 360665664, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-358-2440 |
Authorized person
| Name | DR. GEORGE NICHOLAS EISCHENS |
| Role | OWNER CEO |
| Phone | 3343582440 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | S983TA555 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 152WV0400X - Vision Therapy Optometrist |
| License Number | S983TA555 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 051509621 |
| State | AL |
| Issuer | UNITED HEALTHCARE |
| Number | 22-00012 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529911890 |
| State | AL |
| Issuer | RAILROAD MEDICARE |
| Number | P00201800 |
| Issuer | MEDICAID |
| Number | 051509621 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| EISCHENS, GEORGE N | Agent | 1807 STATION DRIVE SUITE APRATTVILLE, AL 36066 |
| Name | Role | Address |
|---|---|---|
| EISCHENS, GEORGE N | Member | 1807 STATION DRIVE SUITE APRATTVILLE, AL 36066 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
