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General NPI Number Information
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NPI Number | 1750761375
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Entity Type | Organization
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Legal Business Name | CONGLETON EYE CARE, LLC
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Dates
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Enumeration Date | 06/09/2015
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Last Update Date | 09/25/2015
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Provider Practice Location Address
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Address Line | 4600 MOBILE HWY SUITE 122
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City | PENSACOLA
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State | FL
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Zip | 32506
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Country | US
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Telephone | 850-455-0722
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Fax | 850-455-0723
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Provider Business Mailing Address
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Address Line | 4600 MOBILE HWY #9 PMB 139
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City | PENSACOLA
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State | FL
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Zip | 32506
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Country | US
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Telephone | 850-455-0722
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Fax | 850-455-0723
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMIE CONGLETON
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Credential | O.D.
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Telephone | 850-455-0722
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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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