Provider Demographics
NPI:1447768221
Name:OPTICS OF LIFE LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:OPTICS OF LIFE LIMITED LIABILITY COMPANY
Other - Org Name:BALDWIN OPTICAL AND HEARING AID
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-676-1131
Mailing Address - Street 1:310 E LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2618
Mailing Address - Country:US
Mailing Address - Phone:251-943-1758
Mailing Address - Fax:
Practice Address - Street 1:310 E LAUREL AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2618
Practice Address - Country:US
Practice Address - Phone:251-943-1758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty