Provider Demographics
NPI:1588822274
Name:SHOALS VISION CLINIC, INC.
Entity Type:Organization
Organization Name:SHOALS VISION CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-381-0100
Mailing Address - Street 1:1202B WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2234
Mailing Address - Country:US
Mailing Address - Phone:256-381-0100
Mailing Address - Fax:256-381-4958
Practice Address - Street 1:1202B WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2234
Practice Address - Country:US
Practice Address - Phone:256-381-0100
Practice Address - Fax:256-381-4958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS423332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4731570001Medicare NSC