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General NPI Number Information
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NPI Number | 1104943729
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Entity Type | Organization
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Legal Business Name | MEDICAL VISION ASSOCIATES OF NORTHPORT
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3101 MAIN AVE SUITE C
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City | NORTHPORT
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State | AL
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Zip | 35476-3111
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Country | US
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Telephone | 205-330-0705
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Fax | 205-330-1750
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Provider Business Mailing Address
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Address Line | 3101 MAIN AVE SUITE C
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City | NORTHPORT
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State | AL
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Zip | 35476-3111
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Country | US
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Telephone | 205-330-0705
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Fax | 205-330-1750
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Authorized Official
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Title or Position | OPTICIAN
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Name | MR. LARRY HUGH SUMNER
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Credential |
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Telephone | 205-330-0705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 4669
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License Number State | AL
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