Provider Demographics
NPI:1134284318
Name:ALBERTVILLE FAMILY OPTICAL, PC
Entity type:Organization
Organization Name:ALBERTVILLE FAMILY OPTICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-878-9027
Mailing Address - Street 1:P.O. BOX 404
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950
Mailing Address - Country:US
Mailing Address - Phone:256-878-9027
Mailing Address - Fax:256-891-7855
Practice Address - Street 1:8425 US HIGHWAY 431 N
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950
Practice Address - Country:US
Practice Address - Phone:256-878-9027
Practice Address - Fax:256-891-7855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALST410TA319152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-59564OtherBCBS
AL000059564Medicaid
AL000059564Medicare PIN
AL510-59564OtherBCBS
ALT689364Medicare UPIN
AL000059564Medicaid