Provider Demographics
NPI:1376712331
Name:SCOTTSBORO VISION CENTER LLC
Entity Type:Organization
Organization Name:SCOTTSBORO VISION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:ATCHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-259-6507
Mailing Address - Street 1:323 PARKS AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2411
Mailing Address - Country:US
Mailing Address - Phone:256-259-6507
Mailing Address - Fax:256-259-6516
Practice Address - Street 1:323 PARKS AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2411
Practice Address - Country:US
Practice Address - Phone:256-259-6507
Practice Address - Fax:256-259-6516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1189220001Medicare NSC