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General NPI Number Information
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NPI Number | 1356468755
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Entity Type | Organization
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Legal Business Name | ALVERNON OPTICAL, INC.
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1212 E 32ND ST
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City | SILVER CITY
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State | NM
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Zip | 88061-7229
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Country | US
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Telephone | 505-538-2770
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Fax | 520-538-9611
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Provider Business Mailing Address
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Address Line | 1212 E 32ND ST
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City | SILVER CITY
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State | NM
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Zip | 88061-7229
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Country | US
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Telephone | 505-538-2770
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Fax | 520-538-9611
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Authorized Official
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Title or Position | VP OF RETAIL
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Name | STACIA A DECKER
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Credential | LDO
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Telephone | 520-327-6215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 813
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License Number State | AZ
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