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General NPI Number Information
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NPI Number | 1558403568
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Entity Type | Organization
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Legal Business Name | JEMISON EYE CARE LLC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 24810 US HIGHWAY 31
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City | JEMISON
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State | AL
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Zip | 35085-7876
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Country | US
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Telephone | 205-688-1010
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 730
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City | JEMISON
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State | AL
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Zip | 35085-0730
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Country | US
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Telephone | 205-688-1010
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN OF BOARD OF DIRECTORS
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Name | DR. LISA R GREEN
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Credential | O.D.
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Telephone | 205-688-1010
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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 | S-A35-TA-588
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License Number State | AL
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