Provider Demographics
NPI:1104222934
Name:MARVELOUS EYES, LLC
Entity Type:Organization
Organization Name:MARVELOUS EYES, LLC
Other - Org Name:DEERFOOT EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-683-3232
Mailing Address - Street 1:419 JOHN HENRY WAY STE C
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757-9608
Mailing Address - Country:US
Mailing Address - Phone:256-325-9175
Mailing Address - Fax:
Practice Address - Street 1:419 JOHN HENRY WAY STE C
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35757-9608
Practice Address - Country:US
Practice Address - Phone:256-325-9175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty