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General NPI Number Information
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NPI Number | 1336173350
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Entity Type | Organization
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Legal Business Name | PELT EYE CLINIC, P.A.
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 03/28/2008
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Provider Practice Location Address
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Address Line | 4340 LAFAYETTE ST
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City | MARIANNA
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State | FL
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Zip | 32446-2916
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Country | US
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Telephone | 850-482-2336
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Fax | 850-526-5337
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Provider Business Mailing Address
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Address Line | PO BOX 6054
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City | MARIANNA
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State | FL
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Zip | 32447-6054
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Country | US
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Telephone | 850-482-2336
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Fax | 850-526-5337
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALAN E PELT
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Credential | OD
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Telephone | 850-482-2336
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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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