Provider Demographics
NPI:1679026090
Name:EYEGLASSES SERVICES ON WHEELS
Entity Type:Organization
Organization Name:EYEGLASSES SERVICES ON WHEELS
Other - Org Name:HALL OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISPENSING OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED OPTICIAN
Authorized Official - Phone:205-393-5734
Mailing Address - Street 1:101 OLD HACKBERRY LN
Mailing Address - Street 2:1209
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-7460
Mailing Address - Country:US
Mailing Address - Phone:205-393-5734
Mailing Address - Fax:
Practice Address - Street 1:101 OLD HACKBERRY LN
Practice Address - Street 2:1209
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7460
Practice Address - Country:US
Practice Address - Phone:205-393-5734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALASDO332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier