Healthcare Provider Details

I. General information

NPI: 1932462264
Provider Name (Legal Business Name): MUSCLE SHOALS EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 AVALON AVE
MUSCLE SHOALS AL
35661-2404
US

IV. Provider business mailing address

711 COX CREEK PKWY
FLORENCE AL
35630-1001
US

V. Phone/Fax

Practice location:
  • Phone: 256-766-3139
  • Fax: 256-767-7374
Mailing address:
  • Phone: 256-766-3139
  • Fax: 256-767-7374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS722TA009
License Number StateAL

VIII. Authorized Official

Name: HEATHER L DAVIS
Title or Position: OFFICE MGR
Credential:
Phone: 256-766-3139