Healthcare Provider Details

I. General information

NPI: 1598825945
Provider Name (Legal Business Name): SAFETY SOURCE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 RANGELINE RD
THEODORE AL
36582-5207
US

IV. Provider business mailing address

PO BOX 190637
MOBILE AL
36619-0637
US

V. Phone/Fax

Practice location:
  • Phone: 251-443-7445
  • Fax: 251-443-8090
Mailing address:
  • Phone: 251-443-7445
  • Fax: 251-443-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. KEITH SKIPWORTH
Title or Position: PRESIDENT
Credential:
Phone: 251-443-7445