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General NPI Number Information
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NPI Number | 1770635625
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Entity Type | Organization
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Legal Business Name | JULIE MOON INC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 113 S J WHITE BLVD
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City | TALLADEGA
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State | AL
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Zip | 35160
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Country | US
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Telephone | 256-362-6466
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Fax |
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Provider Business Mailing Address
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Address Line | 113 SJ WHITE BLVD
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City | TALLADEGA
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State | AL
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Zip | 35160
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Country | US
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Telephone | 256-362-6466
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OPTICIAN
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Name | JULIE M MOON
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Credential | OPTICIAN
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Telephone | 256-362-6466
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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 |
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License Number State |
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