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General NPI Number Information
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NPI Number | 1396890455
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Entity Type | Organization
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Legal Business Name | MCLENDON & SONS OPTICAL 2
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 08/10/2007
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Provider Practice Location Address
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Address Line | 725 STATE ST
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City | MUSCLE SHOALS
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State | AL
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Zip | 35661-2939
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Country | US
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Telephone | 256-314-1125
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Fax | 256-381-2323
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Provider Business Mailing Address
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Address Line | PO BOX 3781
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City | MUSCLE SHOALS
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State | AL
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Zip | 35662-3781
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Country | US
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Telephone | 256-314-1125
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. CHARLES KENNON BERRY SR.
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Credential | O.D.
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Telephone | 256-314-1125
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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 | S425TA230
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License Number State | AL
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