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General NPI Number Information
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NPI Number | 1548663016
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Entity Type | Organization
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Legal Business Name | EAST ALABAMA OPTICAL SHOP, LLC
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Dates
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Enumeration Date | 09/29/2014
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | 1805 LAKESIDE CIR
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City | AUBURN
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State | AL
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Zip | 36830-2825
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Country | US
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Telephone | 334-321-9700
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Fax | 334-321-9694
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Provider Business Mailing Address
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Address Line | 1805 LAKESIDE CIR
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City | AUBURN
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State | AL
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Zip | 36830-2825
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Country | US
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Telephone | 334-321-9700
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Fax | 334-321-9694
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. BERTRAND M. ANZ II
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Credential | M.D.
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Telephone | 334-821-3838
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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 |
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License Number State |
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