Provider Demographics
NPI:1922432574
Name:PINNACLE OPTICAL LLC
Entity Type:Organization
Organization Name:PINNACLE OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-542-0541
Mailing Address - Street 1:1900 CRESTWOOD BLVD
Mailing Address - Street 2:STE 304
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2034
Mailing Address - Country:US
Mailing Address - Phone:205-951-4466
Mailing Address - Fax:
Practice Address - Street 1:1900 CRESTWOOD BLVD
Practice Address - Street 2:STE 304
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2034
Practice Address - Country:US
Practice Address - Phone:205-951-4466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty