Individual
MR. LAVELL EDWARD BROOKS SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
234 N PRAIRIE STREET, UNION SPRINGS, AL 36089
(334) 324-6832
Mailing address
3160 BOZEMAN DR, MONTGOMERY, AL 36108-3944
(334) 324-6832
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
6136761
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6136761
—
AL
Enumeration date
07/25/2017
Last updated
07/25/2017
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