Provider Demographics
NPI:1659641579
Name:YOUR EYES OPTICAL
Entity Type:Organization
Organization Name:YOUR EYES OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEDDLES
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:256-423-5850
Mailing Address - Street 1:25134 MOORESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ELKMONT
Mailing Address - State:AL
Mailing Address - Zip Code:35620-3643
Mailing Address - Country:US
Mailing Address - Phone:256-423-5850
Mailing Address - Fax:
Practice Address - Street 1:1260 US HIGHWAY 72 E
Practice Address - Street 2:SUITE C
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-5136
Practice Address - Country:US
Practice Address - Phone:256-423-5850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty