MEDICARE: LOIS HOLLINGSWORTH OPTICIAN

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	:	1578911962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOIS HOLLINGSWORTH OPTICIAN

Provider Business Mailing Address
First Line	:	PO BOX 94
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-0094
Country	:	US
Telephone Number	:	251-239-8270
Fax Number	:	251-239-8269

Provider Business Practice Location Address
First Line	:	2012 HAND AVE
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4115
Country	:	US
Telephone Number	:	251-487-2442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2016
Last Update Date	:	05/26/2016

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