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General NPI Number Information
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NPI Number | 1811383722
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Entity Type | Organization
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Legal Business Name | NORTHPORT VISION CENTER LLC
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Dates
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Enumeration Date | 04/08/2015
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 5710 MCFARLAND BLVD
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City | NORTHPORT
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State | AL
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Zip | 35476-3539
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Country | US
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Telephone | 205-333-7859
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Fax |
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Provider Business Mailing Address
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Address Line | 13824 RANDA PKWY
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City | NORTHPORT
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State | AL
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Zip | 35475-6003
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTHONY AUSTIN
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Credential | O.D.
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Telephone | 205-333-7859
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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 | S960TA520
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License Number State | AL
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