MEDICARE: AJS INDUSTRIES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1043834492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AJS INDUSTRIES INC

Provider Business Mailing Address
First Line	:	3922 US HIGHWAY 80 W STE A
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36870-6514
Country	:	US
Telephone Number	:	344-408-4083
Fax Number	:

Provider Business Practice Location Address
First Line	:	3922 US HIGHWAY 80 W STE A
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36870-6514
Country	:	US
Telephone Number	:	334-408-4083
Fax Number	:	334-408-4083

Authorized Official
Title or Position	:	OWNER
Name	:	SARA ANN UNDEREWOOD
Credential	:	OPTICAIN
Telephone Number	:	334-408-4083

Provider Enumeration Date	:	06/02/2020
Last Update Date	:	08/04/2020

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