Healthcare Provider Details

I. General information

NPI: 1780981662
Provider Name (Legal Business Name): DEBORAH EDWARDS DBA DISCOUNT OPTICAL DEPOT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 NORTH ST E
TALLADEGA AL
35160-2502
US

IV. Provider business mailing address

134 BYNUM ACRES DR
ANNISTON AL
36201-6829
US

V. Phone/Fax

Practice location:
  • Phone: 256-268-8383
  • Fax:
Mailing address:
  • Phone: 256-613-4874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH DENSON EDWARDS
Title or Position: OWNER
Credential:
Phone: 256-268-8383