Provider Demographics
NPI:1780902304
Name:CARMICHAEL OPTICAL SHOPPE, INC
Entity type:Organization
Organization Name:CARMICHAEL OPTICAL SHOPPE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:R
Authorized Official - Last Name:YONKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:334-277-9111
Mailing Address - Street 1:8007 US HIGHWAY 231
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092-2062
Mailing Address - Country:US
Mailing Address - Phone:334-567-9106
Mailing Address - Fax:334-567-8004
Practice Address - Street 1:8007 US HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092-2062
Practice Address - Country:US
Practice Address - Phone:334-567-9106
Practice Address - Fax:334-567-8004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARMICHAEL OPTICAL SHOPPE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-06
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL134499332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0756330002Medicare UPIN