Provider Demographics
NPI:1174011209
Name:PINNACLE OPTICAL, LLC
Entity Type:Organization
Organization Name:PINNACLE OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-542-0541
Mailing Address - Street 1:1900 CRESTWOOD BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2056
Mailing Address - Country:US
Mailing Address - Phone:205-542-0541
Mailing Address - Fax:205-278-8770
Practice Address - Street 1:1900 CRESTWOOD BLVD STE 100
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2056
Practice Address - Country:US
Practice Address - Phone:205-542-0541
Practice Address - Fax:205-278-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier