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General NPI Number Information
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NPI Number | 1023594603
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Entity Type | Organization
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Legal Business Name | DECATUR FAMILY EYE CARE LLC
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 1313 13TH AVE SE
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City | DECATUR
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State | AL
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Zip | 35601-4308
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Country | US
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Telephone | 256-353-1787
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Fax | 256-350-6041
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Provider Business Mailing Address
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Address Line | 1313 13TH AVE SE
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City | DECATUR
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State | AL
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Zip | 35601-4308
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Country | US
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Telephone | 256-353-1787
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | JONATHAN DAVIS
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Credential | OD
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Telephone | 662-571-1654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | S-E06
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License Number State | AL
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