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General NPI Number Information
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NPI Number | 1578590733
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Entity Type | Organization
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Legal Business Name | EYE LAB VISION CENTER, INC.
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 2011 HIGHWAY 280 BYPASS
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City | PHENIX CITY
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State | AL
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Zip | 36867
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Country | US
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Telephone | 334-480-4015
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Fax | 334-448-9918
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Provider Business Mailing Address
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Address Line | 2011 HIGHWAY 280 BYPASS
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City | PHENIX CITY
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State | AL
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Zip | 36867
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Country | US
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Telephone | 334-480-4015
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Fax | 334-448-9918
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. GRADY STONE II
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Credential | L.D.O
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Telephone | 334-480-4015
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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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