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General NPI Number Information
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NPI Number | 1588788418
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Entity Type | Organization
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Legal Business Name | CITY OPTICAL INC
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Dates
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Enumeration Date | 03/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 211 LOVE AVE
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City | TIFTON
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State | GA
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Zip | 31794-4453
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Country | US
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Telephone | 229-382-9751
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Fax | 229-382-9775
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Provider Business Mailing Address
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Address Line | 211 LOVE AVE
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City | TIFTON
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State | GA
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Zip | 31794-4453
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Country | US
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Telephone | 229-382-9751
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Fax | 229-382-9775
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Authorized Official
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Title or Position | PRESIDENT CO OWNER
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Name | MR. JOHN T HALL JR.
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Credential | L.D.O.
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Telephone | 229-382-9751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | GA1410
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License Number State | GA
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