MEDICARE: BERRY OPTICAL LABORATORIES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1124174529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERRY OPTICAL LABORATORIES INC

Provider Business Mailing Address
First Line	:	5550 WARES FERRY RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117
Country	:	US
Telephone Number	:	334-271-3937
Fax Number	:	334-279-7434

Provider Business Practice Location Address
First Line	:	5550 WARES FERRY RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117
Country	:	US
Telephone Number	:	334-271-3937
Fax Number	:	334-279-7434

Authorized Official
Title or Position	:	OWNER OPTICIAN
Name	:	MR. WILLIAM T STONE
Credential	:	OPTICIAN
Telephone Number	:	334-271-3937

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	12/21/2022

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