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General NPI Number Information
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NPI Number | 1578589107
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Entity Type | Organization
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Legal Business Name | MAYNOR & MITCHELL OPTICAL SHOP LLC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 3501 MEMORIAL PKWY SW STE 200
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City | HUNTSVILLE
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State | AL
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Zip | 35801-6901
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Country | US
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Telephone | 256-533-0315
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Fax | 256-536-0360
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Provider Business Mailing Address
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Address Line | 3501 MEMORIAL PKWY SW STE 200
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City | HUNTSVILLE
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State | AL
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Zip | 35801-6901
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Country | US
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Telephone | 256-533-0315
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Fax | 256-536-0360
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM N MITCHELL
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Credential | M.D.
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Telephone | 256-533-0315
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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 | MD21789
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License Number State | AL
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Taxonomy #2
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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 | AL
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