Provider Demographics
NPI:1356307854
Name:PRESCRIPTION EYEWEAR, INC.
Entity Type:Organization
Organization Name:PRESCRIPTION EYEWEAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:MR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:O
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-271-4664
Mailing Address - Street 1:645 MCQUEEN SMITH RD N
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7268
Mailing Address - Country:US
Mailing Address - Phone:334-365-9911
Mailing Address - Fax:
Practice Address - Street 1:645 MCQUEEN SMITH RD N
Practice Address - Street 2:SUITE 109
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7268
Practice Address - Country:US
Practice Address - Phone:334-365-9911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0682390002Medicare ID - Type Unspecified