Provider Demographics
NPI:1699858860
Name:OZARK ONE-HOUR OPTICAL, INC.
Entity Type:Organization
Organization Name:OZARK ONE-HOUR OPTICAL, INC.
Other - Org Name:OZARK OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-774-4703
Mailing Address - Street 1:1892 ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-3724
Mailing Address - Country:US
Mailing Address - Phone:334-774-4703
Mailing Address - Fax:334-774-4725
Practice Address - Street 1:1892 ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-3724
Practice Address - Country:US
Practice Address - Phone:334-774-4703
Practice Address - Fax:334-774-4725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10273156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51518998OtherBLUECROSS/BLUESHIELD