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General NPI Number Information
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NPI Number | 1447875919
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Entity Type | Organization
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Legal Business Name | BROOKSTONE OPTICAL LLC
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 1201 POWDER PLANT RD UNIT 15
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City | BESSEMER
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State | AL
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Zip | 35022-5247
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Country | US
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Telephone | 205-477-0229
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Fax | 205-477-0239
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Provider Business Mailing Address
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Address Line | 1201 POWDER PLANT RD UNIT 15
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City | BESSEMER
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State | AL
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Zip | 35022-5247
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Country | US
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Telephone | 205-477-0229
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Fax | 205-477-0239
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | JESSETTA CARGUS
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Credential | OD
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Telephone | 205-477-0229
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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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