Healthcare Provider Details

I. General information

NPI: 1003144734
Provider Name (Legal Business Name): QUALITY EYEWEAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 PRINCETON AVE SW
BIRMINGHAM AL
35211-1320
US

IV. Provider business mailing address

832 PRINCETON AVE SW
BIRMINGHAM AL
35211-1320
US

V. Phone/Fax

Practice location:
  • Phone: 205-397-2287
  • Fax: 205-397-0985
Mailing address:
  • Phone: 205-397-2287
  • Fax: 205-397-0985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number09010865
License Number StateAL

VIII. Authorized Official

Name: DR. GERALD SIMON
Title or Position: PRESIDENT
Credential: OD
Phone: 205-397-2287