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General NPI Number Information
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NPI Number | 1366569766
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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 | 10/30/2008
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Provider Practice Location Address
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Address Line | 4747 E SUNRISE DR
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City | TUCSON
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State | AZ
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Zip | 85718-8500
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Country | US
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Telephone | 520-299-4000
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Fax | 520-577-7656
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Provider Business Mailing Address
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Address Line | 4747 E SUNRISE DR
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City | TUCSON
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State | AZ
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Zip | 85718-8500
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Country | US
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Telephone | 520-299-4000
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Fax | 520-577-7656
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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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