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General NPI Number Information
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NPI Number | 1184960288
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Entity Type | Organization
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Legal Business Name | LOVE YOUR EYES, LLC
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Dates
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Enumeration Date | 12/17/2012
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 15255 HIGHWAY 43
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-1924
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Country | US
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Telephone | 205-238-4466
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Fax |
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Provider Business Mailing Address
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Address Line | 160 GREEN ACRES BLVD
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City | TRAFFORD
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State | AL
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Zip | 35172-8782
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Country | US
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Telephone | 205-238-4466
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | TRACY MULVEHILL MILLWOOD
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Credential | O.D.
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Telephone | 205-238-4466
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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-C91-TA-938
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License Number State | AL
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