Healthcare Provider Details

I. General information

NPI: 1508868399
Provider Name (Legal Business Name): PRESCRIPTION EYEWEAR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2752 ZELDA RD
MONTGOMERY AL
36106-2694
US

IV. Provider business mailing address

2752 ZELDA RD
MONTGOMERY AL
36106-2694
US

V. Phone/Fax

Practice location:
  • Phone: 334-271-4664
  • Fax: 334-271-4687
Mailing address:
  • Phone: 334-271-4664
  • Fax: 334-271-4687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberN/A
License Number StateAL

VIII. Authorized Official

Name: CANDICE DAVIS
Title or Position: VP
Credential:
Phone: 916-990-7590