Provider Demographics
NPI:1699841601
Name:OWENS OPTICAL OF WETUMPKA INC
Entity Type:Organization
Organization Name:OWENS OPTICAL OF WETUMPKA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MERVIN
Authorized Official - Last Name:SUNDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-567-2282
Mailing Address - Street 1:6255 US HIGHWAY 231
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092-2831
Mailing Address - Country:US
Mailing Address - Phone:334-567-2282
Mailing Address - Fax:334-514-1134
Practice Address - Street 1:6255 US HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092-2831
Practice Address - Country:US
Practice Address - Phone:334-567-2282
Practice Address - Fax:334-514-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51059498OtherBLUE CROSS BLUE SHIELD
AL51059704OtherBLUE CROSS BLUE SHIELD
AL51059498OtherBLUE CROSS BLUE SHIELD