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General NPI Number Information
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NPI Number | 1285117226
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Entity Type | Organization
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Legal Business Name | PERFORMANCE VISION CARE, PC
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Dates
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Enumeration Date | 09/14/2018
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Last Update Date | 09/14/2018
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Provider Practice Location Address
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Address Line | 6511 HIGHWAY 431 S STE A
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City | OWENS CROSS ROADS
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State | AL
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Zip | 35763-9217
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Country | US
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Telephone | 256-469-6427
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Fax |
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Provider Business Mailing Address
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Address Line | 6511 HIGHWAY 431 S STE A
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City | OWENS CROSS ROADS
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State | AL
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Zip | 35763-9217
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Country | US
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Telephone | 256-469-6427
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH WINTON
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Credential | OD
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Telephone | 256-755-2421
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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 |
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License Number State |
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