MEDICARE: LOOK BALDWIN VISION LLC

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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1659833432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOOK BALDWIN VISION LLC

Provider Business Mailing Address
First Line	:	1651 SCHILLINGER RD N
Second Line	:
City	:	SEMMES
State	:	AL
Zip	:	36575-7409
Country	:	US
Telephone Number	:	251-706-7960
Fax Number	:	251-375-0444

Provider Business Practice Location Address
First Line	:	4751 MAIN ST STE F217
Second Line	:
City	:	ORANGE BEACH
State	:	AL
Zip	:	36561-5862
Country	:	US
Telephone Number	:	251-213-2077
Fax Number	:	251-375-0444

Authorized Official
Title or Position	:	COMPANY MANAGER
Name	:	TERRI HANKINSON
Credential	:
Telephone Number	:	251-706-7960

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	04/02/2019

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