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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