DECATUR OPTICAL DISPENSARY; NPI #1629014469

Contact Information

DECATUR OPTICAL DISPENSARY
LBN DECATUR OPTICAL DISPENSARY

201 6TH AVE. SE
DECATUR, AL 35601

Phone: 256-351-0040
Fax: 256-301-9449
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Eyewear Supplier	332H00000X	87	All Other Suppliers

Indicates primary specialty

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NPI Profile & details for DECATUR OPTICAL DISPENSARY

NPI # 1629014469

LBN Legal business name DECATUR OPTICAL DISPENSARY

DBA Doing business as DECATUR OPTICAL DISPENSARY

Authorized official JACK HOLBERT - (PRESIDENT)

Entity Organization

Organization subpart ¹ No

Enumeration date 06/21/2006

Last updated 01/14/2015 - About 11 years ago

Identifiers

Medicaid

000059076

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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