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General NPI Number Information
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NPI Number | 1134284318
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Entity Type | Organization
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Legal Business Name | ALBERTVILLE FAMILY OPTICAL, PC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 8425 US HIGHWAY 431 N
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City | ALBERTVILLE
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State | AL
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Zip | 35950
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Country | US
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Telephone | 256-878-9027
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Fax | 256-891-7855
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Provider Business Mailing Address
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Address Line | P.O. BOX 404
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City | ALBERTVILLE
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State | AL
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Zip | 35950
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Country | US
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Telephone | 256-878-9027
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Fax | 256-891-7855
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONNA L LEE
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Credential | O.D.
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Telephone | 256-878-9027
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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 | ST410TA319
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License Number State | AL
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