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General NPI Number Information
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NPI Number | 1356146013
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Entity Type | Organization
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Legal Business Name | LEGACY EYE CARE
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 6140A UNIVERSITY DR NW
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City | HUNTSVILLE
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State | AL
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Zip | 35806-1710
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Country | US
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Telephone | 256-837-5642
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Fax | 256-803-2384
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Provider Business Mailing Address
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Address Line | 231 BRIGHTON PARK WAY
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City | MADISON
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State | AL
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Zip | 35756-4931
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Country | US
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Telephone | 205-370-9430
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LATISHA MARBUARY
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Credential | OD
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Telephone | 205-370-9430
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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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