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General NPI Number Information
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NPI Number | 1679795397
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Entity Type | Organization
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Legal Business Name | HOUR GLASS INC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 12/29/2010
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Provider Practice Location Address
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Address Line | 1433 E LAFAYETTE ST
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City | TALLAHASSEE
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State | FL
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Zip | 32301-4747
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Country | US
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Telephone | 850-877-4687
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Fax | 850-877-0551
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Provider Business Mailing Address
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Address Line | 1480 TIMBERLANE RD
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City | TALLAHASSEE
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State | FL
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Zip | 32312-1713
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Country | US
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Telephone | 850-893-4687
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Fax | 850-893-6098
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES A STEPHENS
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Credential | OD
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Telephone | 850-893-4687
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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 | 198700209840036
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License Number State | FL
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