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General NPI Number Information
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NPI Number | 1730241720
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Entity Type | Organization
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Legal Business Name | SARRELL REGIONAL OPTICAL CENTER
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 223 HAYNES ST
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City | TALLADEGA
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State | AL
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Zip | 35160-2559
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Country | US
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Telephone | 256-463-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 226 BROCKFORD RD
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City | HEFLIN
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State | AL
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Zip | 36264-1608
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Country | US
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Telephone | 256-463-2700
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Fax |
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Authorized Official
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Title or Position | HUMAN RESOURCES OSHA
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Name | ERIN M SWANSON
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Credential |
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Telephone | 256-463-2700
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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 | S-B35-TA-733
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License Number State | AL
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