Healthcare Provider Details

I. General information

NPI: 1306760897
Provider Name (Legal Business Name): HIBBETT OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 N BROAD ST
WETUMPKA AL
36092-2406
US

IV. Provider business mailing address

309 N BROAD ST
WETUMPKA AL
36092-2406
US

V. Phone/Fax

Practice location:
  • Phone: 256-335-0268
  • Fax:
Mailing address:
  • Phone: 256-335-0268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. IRA KNEELAND HIBBETT JR.
Title or Position: OWNER
Credential:
Phone: 256-335-0268