Provider Demographics
NPI:1598323438
Name:EYES ON ALBERTVILLE, LLC
Entity Type:Organization
Organization Name:EYES ON ALBERTVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUSSIE
Authorized Official - Middle Name:BELL
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-276-6738
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-0012
Mailing Address - Country:US
Mailing Address - Phone:256-878-3024
Mailing Address - Fax:
Practice Address - Street 1:390 GUNTER AVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-1129
Practice Address - Country:US
Practice Address - Phone:256-878-3024
Practice Address - Fax:256-660-6150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYES ON ALBERTVILLE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty