Provider Demographics
NPI:1457412645
Name:AMAZING EYES L.L.C.
Entity Type:Organization
Organization Name:AMAZING EYES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ABOC OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:STORM
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:251-955-3939
Mailing Address - Street 1:7685 STATE HIGHWAY 59
Mailing Address - Street 2:SUITE A
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-3946
Mailing Address - Country:US
Mailing Address - Phone:251-955-3939
Mailing Address - Fax:251-955-3940
Practice Address - Street 1:7685 STATE HIGHWAY 59
Practice Address - Street 2:SUITE A
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-3946
Practice Address - Country:US
Practice Address - Phone:251-955-3939
Practice Address - Fax:251-955-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6151510001Medicare NSC