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General NPI Number Information
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NPI Number | 1679026090
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Entity Type | Organization
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Legal Business Name | EYEGLASSES SERVICES ON WHEELS
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Dates
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Enumeration Date | 08/02/2016
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 101 OLD HACKBERRY LN 1209
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City | TUSCALOOSA
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State | AL
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Zip | 35401-7460
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Country | US
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Telephone | 205-393-5734
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Fax |
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Provider Business Mailing Address
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Address Line | 101 OLD HACKBERRY LN 1209
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City | TUSCALOOSA
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State | AL
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Zip | 35401-7460
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Country | US
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Telephone | 205-393-5734
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Fax |
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Authorized Official
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Title or Position | DISPENSING OPTICIAN
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Name | TIMOTHY GRANT HALL
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Credential | CERTIFIED OPTICIAN
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Telephone | 205-393-5734
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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 | ASDO
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License Number State | AL
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