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General NPI Number Information
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NPI Number | 1538371075
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Entity Type | Organization
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Legal Business Name | EYEDOCS ON WHEELS PC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15255 HWY 43
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City | RUSSELLVILLE
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State | AL
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Zip | 35653
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Country | US
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Telephone | 256-332-5440
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Fax | 256-332-5402
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Provider Business Mailing Address
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Address Line | PO BOX 95
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City | RUSSELLVILLE
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State | AL
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Zip | 35653
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Country | US
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Telephone | 256-332-5440
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Fax | 256-332-5402
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Authorized Official
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Title or Position | OWNER
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Name | DR. STUART GREENBERG
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Credential | O.D.
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Telephone | 256-332-5440
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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 | OPT002359
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License Number State | GA
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