Healthcare Provider Details

I. General information

NPI: 1417449216
Provider Name (Legal Business Name): SHOW VISION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 MONUMENT DR
MILLBROOK AL
36054
US

IV. Provider business mailing address

758 MONUMENT DR
MILLBROOK AL
36054-1849
US

V. Phone/Fax

Practice location:
  • Phone: 334-694-9001
  • Fax: 334-517-4668
Mailing address:
  • Phone: 334-694-9001
  • Fax: 334-517-4668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS831TA373
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: DR. DENISE M. SHOW
Title or Position: OWNER
Credential: OD
Phone: 334-694-9001