Organization
SULLINS EYE CARE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNNE TIDWELL (BUSINESS MANAGER)
(256) 464-6670
Entity
Organization
Contact information
Practice address
7540 MEMORIAL PKWY SW, SUITE Q, HUNTSVILLE, AL 35802-2265
(256) 880-1966
(256) 880-6805
Mailing address
7540 MEMORIAL PKWY SW, SUITE Q, HUNTSVILLE, AL 35802-2265
(256) 880-1966
(256) 880-6805
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-761-TA-167
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G900
MEDICARE GROUP PIN
AL
Enumeration date
12/18/2007
Last updated
11/21/2012
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