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General NPI Number Information
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NPI Number | 1396592382
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Entity Type | Organization
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Legal Business Name | EXCEL EYECARE, LLC
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Dates
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Enumeration Date | 05/06/2024
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 200 WHITEMAN AVE
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City | ELKINS
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State | WV
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Zip | 26241-3400
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Country | US
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Telephone | 615-728-1441
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Fax |
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Provider Business Mailing Address
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Address Line | 236 BARRINGTON CIR
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City | ALEXANDRIA
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State | AL
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Zip | 36250-7205
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Country | US
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Telephone | 256-452-1572
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Fax | 256-546-1094
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JAY MICHAEL JOHNSON
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Credential | OD
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Telephone | 256-452-1572
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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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