Organization
MCLENDON & SONS OPTICAL 2
Active
Parent organization
RUSS OPTICAL SUPERSTORE
Other names
Charles K Berry, O.D.
Organization subpart
Yes
Provider details
NPI number
Legal business name
RUSS OPTICAL SUPERSTORE
Authorized official
DR. CHARLES KENNON BERRY SR. O.D. (OPTOMETRIST)
(256) 314-1125
Entity
Organization
Contact information
Practice address
725 STATE ST, MUSCLE SHOALS, AL 35661-2939
(256) 314-1125
(256) 381-2323
Mailing address
PO BOX 3781, MUSCLE SHOALS, AL 35662-3781
(256) 314-1125
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S425TA230
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396890455
ORGANIZATIONAL NPI
AL
01
—
1528014495
INDIVIDUAL NPI
AL
Enumeration date
01/25/2007
Last updated
08/10/2007
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