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General NPI Number Information
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NPI Number | 1134499452
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Entity Type | Organization
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Legal Business Name | LLY VISION SERVICES INC.
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 300 MARY ESTHER BLVD STE. #47
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City | MARY ESTHER
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State | FL
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Zip | 32569-1693
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Country | US
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Telephone | 850-664-6339
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5836
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City | DESTIN
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State | FL
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Zip | 32540-5836
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LOUIS YARDLEY JR.
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Credential | O.D.
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Telephone | 850-240-2021
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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 | OPC2570
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License Number State | FL
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