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Organization
EAST MONTGOMERY OPTICAL SHOPPE
Active
Organization
EAST MONTGOMERY OPTICAL SHOPPE
Active
Other names
Wetumpka Optical
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILSON GUINN PAULK M.D. (PHYSICAN / OWNER)
(334) 260-8511
Entity
Organization
Contact information
Practice address
262 MITYLENE PARK DR, MONTGOMERY, AL 36117-3548
(334) 260-8511
(334) 260-8755
Mailing address
262 MITYLENE PARK DR, MONTGOMERY, AL 36117-3548
(334) 260-8511
(334) 260-8755
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
332H00000X
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51515037
BCBS
AL
Enumeration date
01/31/2008
Last updated
05/11/2011
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