Provider Demographics
NPI:1841381274
Name:PRECISION OPTICAL, LLC
Entity Type:Organization
Organization Name:PRECISION OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-556-6115
Mailing Address - Street 1:700 HELEN KELLER BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2960
Mailing Address - Country:US
Mailing Address - Phone:205-556-6115
Mailing Address - Fax:205-556-4655
Practice Address - Street 1:700 HELEN KELLER BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2960
Practice Address - Country:US
Practice Address - Phone:205-556-6115
Practice Address - Fax:205-556-4655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL630017644332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51515855OtherBCBS
AL009917625Medicaid
AL4852570001Medicare ID - Type Unspecified